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Biomedical subjects

G Lenz

Publications and source records attributed to G Lenz.

At least 91 records · Page 5Linked to original sources
PubMed1991

[Personality profile in bipolar schizoaffective psychoses. A comparison with bipolar affective psychoses].

The aim of this study was to investigate personality profiles in patients with bipolar affective and schizoaffective disorder, classified according to ICD-9 criteria using objective psychological tests (Personal Research Form, Objective Analytical Test Battery, IPC-Query Form). The bipolar schizoaffective patients were further subtyped according to Research Diagnostic Criteria (RDC) into schizoaffective-affective and schizoaffective-schizophrenic patients. 81 patients took part in the study (29 bipolar affective and 52 bipolar schizoaffective patients; the latter were subtyped into 23 schizoaffective-schizophrenic and 29 schizoaffective-affective patients). We showed that the personality profiles are quite similar in schizoaffective-affective and schizoaffective-schizophrenic patients if compared to purely affective patients. But indeed there are pronounced differences between the schizoaffective-affective and the schizoaffective-schizophrenic subtypes, so that subtyping schizoaffective disorder like done in Research Diagnostic Criteria (RDC) seems to show that schizoaffective disorders are not a homogenous group.

Adult↗
PubMed1990

Oxygen transport by pyridoxylated polyhemoglobin solution.

Pyrodoxylated Polyhemoglobin (PolyHb-PPa) with physiological oxygen affinity (P50 27 mm Hg) was used in vitro and in vivo. The oxygen binding coefficient was 1.1 ml O2/dl/g Hb, the oxygen capacity of 8.5% PolyHb-PPa solution 9.3 ml O2/dl, Hill coefficient 1.7, Met-Hb content below 2%. Exchange transfusion of whole blood with PolyHb-PPa results in a significant, linear increase in total oxygen capacity, in contrast to exchange transfusion with asanguineous solutions. In vitro analysis of oxygen equilibrium curves of mixtures of whole blood with PolyHb-PPa, however, shows a nonlinear release of the additional blood oxygen capacity. Significant amounts of PolyHb-PPa-bound oxygen are made available only when hemodilution exceeds 25%; only at 75% hemodilution does oxygen delivery by PolyHb-PPa account for 50% of the unloaded oxygen. In vivo results after therapy for hemorrhagic shock in minipigs clearly shows the efficacy of oxygen transport by PolyHb-PPa. At 70% hemodilution, PolyHb-PPa bound oxygen was twice that of erythrocytic oxygen. Availability of this additional oxygen capacity was demonstrated by an oxygen extraction ratio of 0.40%. The utility of PolyHb-PPa solution with "normal" P50 in the therapy of moderate anemia, however, remains to be proved.

Animals↗
PubMed1990

Obsessive-compulsive disorder: course and interaction with depression. A review of the literature.

Long-term follow-up studies suggest that obsessive-compulsive disorder (OCD) is commonly associated with co-morbid conditions such as depression anxieties and phobias. In the review of the literature the weaknesses in the current methodology are discussed. The instruments for measurement of severity are lacking reliability and sensitivity to change. Serious questions are asked about whether the measured changes reflect alterations in depression in general, or obsessional phenomena specifically. No instruments exist for the documentation of long-term course of OCD and documentation of psychotherapy and pharmacotherapy. In a preliminary report we want to introduce our own study. Approximately 40 OCD inpatients of the psychiatric clinic, University of Vienna, with and without primary or secondary depression diagnosed simultaneously by DSM-III-R and ICD-9 criteria will be included in the study. In general, the major goal of the preliminary reported study will be the elaboration of predictors for course, outcome and therapy response.

Cross-Sectional Studies↗
PubMed1990

[A comparison of arthrography and magnetic resonance tomography in painful limited movements of the hand].

In 18 patients with unclear pain in the wrist limiting hand movement, arthrography and magnetic resonance imaging (MRI) were compared. The FISP gradient echo sequence turned out to be superior to the T1 weighted spin-echo sequence in the imaging of the triangular fibrocartilage complex. MRI is very sensitive in detecting triangular fibrocartilage lesions and therefore represents a suitable non-invasive screening method. It is, however, not possible to assess the degree of the lesion. Ruptures in carpal tendons could only be diagnosed by means of arthrography.

Adult↗
PubMed1989

Unrecognized endobronchial intubation of emergency patients.

Although intubation of emergency patients in the field is a routine measure, endotracheal tube misplacement remains a serious problem. Using radiologic criteria, the frequency of undetected endobronchial intubation by physicians was determined retrospectively in 100 (78 traumatized) field-intubated adult patients (72 men and 28 women; age, 18 to 90 years; mean age, 39.1 years) consecutively admitted to the University Hospital of Tuebingen, Tuebingen, Federal Republic of Germany, between January 1987 and February 1988. Position of tube tip relative to carina was evaluated on anteroposterior chest radiographs made on admission. Inadvertent endobronchial intubation was not recognized by the physician and the admitting anesthesiologist in 7% of the reviewed cases, and endotracheal positioning of the tube tip near the carina (2 or less cm) occurred in another 13%. While unilateral intubation is not immediately catastrophic, the resulting systemic hypoxemia and hypercapnia are aggravated by potential accompanying injury (eg, lung contusion, hematothorax, pneumothorax, shock, or cerebrocranial trauma), which can lead to secondary damage (eg, acute respiratory insufficiency, ischemic brain damage). Evaluation of the depth of tube insertion with the aid of common clinical techniques is particularly unreliable in the case of thoracic trauma, aspiration, or previously existing pulmonary disease. Suggested measures for prevention of endobronchial intubation are improved and intensified training of emergency staff to increase awareness of and prevent the catastrophic effects of endobronchial malposition of the tube tip, tube shortening before intubation, assessment of insertion depth by checking length scale on the tube, and avoidance of patient head and neck movement.

Adolescent↗
PubMed1989

Computerized documentation for lithium outpatients (routine and research data).

To follow up the status and further outcome of patients with recurrent affective and schizoaffective disorders treated in a lithium/prophylactic treatment outpatient (LOP) clinic the authors have developed a documentation system based on a database, which ASCII files. This system should be useful as a basis for optimal treatment and is helpful for special research purposes regarding prophylactic treatment (lithium salts, carbamazepine, antidepressants, etc.). The documentation system consists of two parts, one for routine documentation system consists of two parts, one for routine monitoring including basic data, global course, and routine form with side-effects, and another one for research purposes with documentation of laboratory findings, EEG, and documentation of every cycle which can be added easily. Moreover, with this documentation system it will be possible to compare results from different research centres.

Computers↗
PubMed1989

Early detection of inadvertent oesophageal intubation: pulse oximetry vs. capnography.

The aim of our retrospective study was to evaluate the efficacy of routine pulse oximetry and capnometry for detection of oesophageal tube misplacement. Patients undergoing ENT interventions at our hospital are routinely monitored by ECG, arterial blood pressure by cuff, capnography, and pulse oximetry. Beat-to-beat values of Sao2 and CO2 waveform were recorded by a graphic printer connected to a microcomputer, ASA I patients were routinely preventilated with FIO2 = 0.3, and ASA II-III patients with FIO2 = 1.0. Anaesthesia was performed by junior anaesthesiologists under the close supervision of a resident. During a 16-month period, 1372 patients were anaesthetized. The records of 21 patients with accidental oesophageal tube misplacement were available for retrospective evaluation. Nine patients were preventilated with FIO2 = 0.3 (ASA I), 12 patients with FIO2 = 1.0 (ASA II-III). Rapid detection of oesophageal tube position as early as the first ventilation is possible by capnometry, because of the highly significant difference in end-tidal CO2 (0.2 +/- 0.2 vol%; tracheal intubation: 3.7 +/- 0.9 vol.%; P less than 0.0001). The present advanced pulse oximetry method does not permit differentiation between oesophageal and tracheal tube position within 30 s in patients preventilated with FIO2 = 1.0. Oesophageal misplacement was detectable within 7.5 +/- 0.9 s in patients preventilated with FIO2 = 0.3 due to a 2.1 +/- 0.8% decrease in Sao2 (P less than 0.001). Our results underscore the significance of capnometry for rapid detection of inadvertent oesophageal intubation. High-resolution pulse oximetry is a valuable supplement but not a substitute for capnometry.

Carbon Dioxide↗
PubMed1989

Availability of treatment and diagnostic labelling.

A sample of pre-1967 case records with a hospital diagnosis of schizoaffective disorder were presented for rediagnosis to members of the present staff of the Institute of Psychiatry/Maudsley Hospital. The raters were asked to make a diagnostic choice of either schizophrenia or schizoaffective disorder or affective disorder and indicate how useful they would consider certain treatments for the present episode and for the long term. There was a significant trend in diagnosis to affective disorder but this trend was not correlated with the usefulness of certain treatments, e.g. lithium, a drug which had not been in use before 1967.

Affective Disorders, Psychotic↗
PubMed1989

[Frequency of hypoxic episodes during general anesthesia in children].

We measured the frequency and extent of arterial hypoxemia during pediatric general anesthesia under routine clinical conditions. The subjects were 91 children (13 newborns, 27 infants, 37 children under 6 years, 14 children under 14 years) with normal heart and lungs scheduled for extrathoracic surgery. Mask anesthesia (spontaneous/assisted ventilation) was performed in 30 cases, endotracheal anesthesia (controlled ventilation) in 61 cases. Arterial oxygen saturation (SaO2) was determined by pulse oximetry at entry into the operating room and recorded continuously from induction of anesthesia to emergence. Hypoxic episodes (minimum duration: 30 s) were classified as slight (SaO2 less than or equal to 95%), minor (SaO2 less than or equal to 90%) and major (SaO2 less than or equal to 85%). The data were analyzed with the Fisher's test. 52% of all children experienced at least one hypoxic episode. Frequency and extent of hypoxic episodes decreased as age and weight of the children increased. Major hypoxic episodes occurred in 54% of the newborns, 26% of the infants, 8% of the children under 6 and 7% of the children under 14. A body weight of 10 kg appeared to constitute a threshold: in children below this weight arterial oxygen desaturation occurred significantly more frequently (p less than 0.001), and the incidence of major episodes was significantly higher (p less than 0.005). Major episodes were almost evenly distributed between induction and awakening from anesthesia, only one episode occurred during maintenance. Desaturation was more likely to occur in intubated children than in those with a mask (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Anesthesia for eye operations in mitochondrial encephalomyelopathy].

Mitochondrial encephalomyopathy involves a disturbance of the mitochondrial respiratory chain, as a result of which the blood lactate level is elevated. In stress situations a lactate acidosis can occur. The disease may be subdivided into three main syndromes: Kearns-Sayre syndrome (KKS), "myoclonus epilepsy with ragged red fibers syndrome" (MERRF), and "mitochondrial myopathy, encephalopathy, lactic acidosis and strokelike episodes syndrome" (MELAS). There are also several intermediate forms. Ophthalmological symptoms are frequent and occasionally have to be treated surgically. A 20-year-old male patient with a mixed form of these syndromes including elements of KSS and MERRF had to undergo cataract extraction. The authors decided to perform the operation under local anesthesia and sedation, with the anesthetist on standby. No problems arose. In all cases where mitochondrial encephalomyopathy is suspected the diagnosis should be confirmed by a muscle biopsy and the risk of cardiac arrest, respiratory insufficiency, and epileptic seizures ruled out prior to surgery. Local anesthesia with sedation appears to be the most favorable form of anesthesia provided the maximum dose is observed and a substance with a high convulsion threshold is chosen. Perioperative monitoring by an anesthetist and temporary provision of a cardiac pacemaker are necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Comments on anesthesia procedures in mitochondrial encephalomyopathy].

Mitochondrial encephalomyopathies (MEMP) are rare diseases caused by a disturbance of the mitochondrial chain of respiration. This prevents pyruvate from being completely integrated into the tricarboxylic acid (Krebs') cycle, and hence there is an accumulation of lactate. Histologically this is marked by the appearance of "ragged red fibres" in the light microscope which, in the electron microscope, are eventually recognised as typical accumulations of pathological mitochondria. The clinical pattern can vary greatly and ranges from ophthalmoplegia via mainly myopathic to encephalopathic forms. The pattern of signs and symptoms enables subclassification into three main syndromes (10): The Kearns-Sayre syndrome (KSS), "myoclonus epilepsy with ragged red fibres syndrome" (MERRF) and "mitochondrial myopathy, encephalopathy, lactic acidosis and strokelike episodes syndrome" (MELAS). Intermediate types, however, are frequent. Furthermore, quite a large number of other syndromes such as the "Toni-Fanconi-Debré syndrome" can be classified among the group of mitochondrial encephalomyopathies.--The patient must be classified as a risk patient. Disturbances of cardiac conduction may require a transient or permanent pacemaker. Increase in oxygen requirement must be avoided to prevent increase in lactate levels and development of lactate acidosis. The severity of the myopathy makes it necessary to exercise caution in the use of benzodiazepines and long-term relaxants. When using local anaesthetics one should consider both their negative dromotropism and the resulting reduction of the epileptic threshold. There is a relative contraindication for spinal and epidural anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1987

Red blood cell T-activation and hemolysis in surgical intensive care patients with severe infections.

The exposure of Thomsen-Friedenreich (T) antigens on RBCs, serum neuraminidase, and serum hemoglobin levels were investigated in 53 adult surgical intensive care unit (ICU) patients with septicemia. Unmasked T-antigens were assayed by a hemagglutination test using peanut agglutinin (PNA) (direct anti-T test), and by an indirect anti-T test employing rabbit anti-PNA globulin. RBC T-activation was demonstrated in 17/53 patients (32%); in 2/53 patients (4%) the direct anti-T test was positive, indicating strong T-exposure. No polyagglutination phenomena were observed. Serum neuraminidase was elevated in 12/17 (71%) patients with T-activation and in 7/36 (19%) patients without T-activation. Free serum hemoglobin was elevated in 12/17 (71%) patients with T-activation and in 5/36 (14%) patients without T-activation. Correlations between T-activation and serum neuraminidase and between T-activation and serum hemoglobin were significant (p less than 0.001). Potentially neuraminidase-releasing bacteria were demonstrated in 13/17 (76%) patients with RBC T-exposure. We conclude that neuraminidase-induced RBC T-activation and subsequent hemolysis may be involved in the pathomechanism of hemolytic anemia in patients with severe infections.

Adult↗
PubMed1987

[Fat/water separation in the NMR tomogram. The imaging of bone marrow reactions in degenerative intervertebral disk changes].

We examined 410 patients with lumbar disc degeneration. In 23% fat suppressing IR sequences and phase contrast techniques displayed marrow reactions in subchondral bone adjacent to the affected discs. Only in some cases conventional MRI sequences were able to depict these marrow reactions. CT, plain X-ray and scintigraphy did not show marrow changes. Bacterial infection was excluded. Histological analysis showed substitution of haematopoietic marrow by fatty tissue, necrobiosis and increase in mucoid extracellular fluid.

Bone Marrow↗