Biomedical subjects
H Evers
Publications and source records attributed to H Evers.
The concentration of lidocaine in follicular fluid when used for paracervical block in a human IVF-ET programme.
Lidocaine is a well-documented local anaesthetic often used for paracervical block (PCB) in pregnant women. For this reason, the substance was used early on for PCB in connection with transvaginal follicle aspiration. However, the concentration reached in follicular fluid after PCB or local infiltration of the vaginal wall has not been previously determined. Furthermore, if lidocaine reaches the follicle, it seems important to determine if the concentration reached influences fertilization and early cleavage of the embryo and the pregnancy rate. The study included 46 women who had PCB with lidocaine (50 mg) and 46 women who had no PCB in connection with follicle aspiration. The mean concentration in follicular fluid was 0.36 +/- 1.1 micrograms/ml. There was no significant difference in lidocaine concentration between follicles containing oocytes that were fertilized and those that were not. Furthermore, the fertilization and cleavage rates did not differ significantly in women with and without PCB with lidocaine. The pregnancy rate did not differ between the two groups. It thus seems that the concentration of lidocaine found in the follicular fluid after PCB with 50 mg lidocaine does not negatively affect fertilization of the human oocyte or early cleavage of the human embryo.
The influence of nifedipine (Corinfar) on pulmonary hypertension in chronic obstructive lung disease.
Calcium antagonists may provide an effective approach to the treatment of pulmonary hypertension disorders. Under this aspect we examined 44 patients by right heart catheterisation at rest and at exercise before and after sublingual application of a single dose of 20 mg nifedipine (Corinfar) as well as under continuous dosage of 30-60 mg daily. In patients with latent pulmonary hypertension we ascertained an efficient significant decrease of PAP, 15 of 18 patients were responders. This protective effect persists in the longterm studies after 1 year as well as after 2 years at equal magnitude. In patients with manifest pulmonary hypertension the influence on pulmonary hemodynamics was not so efficient. This behaviour is caused by morphological fixation of pulmonary hypertension. Therefore the determination of magnitude of pulmonary hypertension by right heart catheterisation is necessary for evaluation of nifedipine therapy.
EMLA: a new topical anesthetic.
Eutectic Mixture of Local Anesthetics (EMLA) containing 5% lidocaine and prilocaine in a cream was found to give effective topical analgesia in normal and diseased skin, making it useful for superficial surgery and various other clinical procedures. To be effective, an adequate amount must be applied under occlusion and at the right time before the intervention.
A good way forward.
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District nursing, the disabled and the elderly: who are the black patients?
Community care research in central Birmingham has shown that disabled and old black people are under-represented on the caseloads of district nurses compared to their white counterparts. Whilst factors suggested as contributing to this (service ethnocentrism and general practitioners as 'gate-keepers') are discussed elsewhere, this paper focuses on those few old and disabled black people who are district nurse patients. Following comparisons between these black and white patient groups, the differing perspectives of black patient and district nurse are explored. Stereotypes and myths, knowledge about each other and language/communication are discussed as important areas which may disadvantage black patients in their interaction with district nurses. Attention is drawn to the urgent need for district nursing to address the issue of black disabled and old people in the community and the accompanying central role of research.
The nursing auxiliary service and the care of elderly patients.
Although nurse auxiliaries comprise a large and rapidly expanding part of the district nursing service, nursing research has largely neglected this group of nurses and the people they see. Using a patient-centred approach, which is a key element of the research, we studied the characteristics of patients who were either physically handicapped, frail elderly or elderly mentally infirm, who make up a large majority of the patients. We found that auxiliaries' patients fell into a typical 'at risk' group; they were older and more likely to be living alone than qualified nurses' patients, and yet they received less frequent visits. Motives for providing and continuing the service to patients were not always related to nursing need, and while recipients were grateful for the service, both they and auxiliaries themselves identified areas of potential improvement. The need to continue to monitor and improve the overall quality, effectiveness and efficiency of the service to patients and potential patients, demands that practitioners, managers and researchers systematically review referral to the service and the work of the nurse auxiliary using a patient-focused approach.
District nurses' patients--issues of caseload management.
Current pressures on all community services mean that practitioners must give more detailed attention to evaluation of patient outcomes and caseload review. District nursing caseloads in one health authority have been examined using a patient-focused approach. Random samples of patients who were either physically disabled, frail elderly, or elderly mentally infirm (n = 202) were examined for the distinctive and differing characteristics, if any, of recently referred and long-stay patients. Recently referred patients in our sample were either terminally ill, or had more chronic physical disorders. Patients who stayed on the books received either injections, general care from qualified staff or baths from nurse auxiliaries. Although covering similar areas of the health authority, nursing teams varied in the proportions of recently referred and long-stay patients, suggesting that individual nurses' caseload management is a crucial determinant of length of time on the books. In particular, nursing and medical review of all patients receiving vitamin B12 injections is urgently called for. In order for caseload monitoring to be facilitated, practitioners need relevant local and patient based data in order to make inter-team comparisons. The findings also have training and management support implications.
Absorption of lidocaine and prilocaine after application of a eutectic mixture of local anesthetics (EMLA) on normal and diseased skin.
A eutectic mixture of 5% lidocaine and prilocaine was applied under occlusion for 1 or 2 hours on 25-100 cm2 areas of normal and diseased skin, and the absorption was followed by measuring the concentrations of the drugs in the draining vein and the general circulation at different time intervals after the application. The analgesic and vascular effects in the skin were also recorded. When the mixture was applied on normal skin the absorption was more rapid from the face than from the forearm. The absorption from diseased skin was faster than that from normal skin, with higher plasma concentrations, and a more rapid but shorter anesthetic effect was noted. With the doses used the plasma levels in the general circulation were 100 times lower than those associated with toxicity. The drug concentrations in the draining vein were highest after treatment of diseased skin and were 2-90 times higher than in the general circulation. The plasma concentrations of lidocaine and prilocaine ran parallel to each other, but the prilocaine level was 10-50% lower than that of lidocaine in the draining vein and 200-300% lower in the general circulation.
[Clinical studies of the effect of physical training therapy on oxygen absorption and pulmonary artery pressure in persons with chronic obstructive lung diseases].
Twenty patients with chronic obstructive bronchitis were submitted to a 6-week rehabilitation program including bicycle training, breathing exercise, inhalation, massage, short wave therapy and others. Before and after 6-week training we investigated ventilatory and blood gas parameters and pulmonary artery pressure at rest and during exercise. There was no change in the oxygen uptake on the same exercise stage. We found an insignificant decrease of the pulmonary artery pressure at rest and during exercise. The physical training has no negative influence on the behaviour of pulmonary pressure. We stated a good effect of physical conditioning on the systemic circulation. The working capacity of all patients improved at the end of the training period.
Put race on the agenda.
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Present research in local analgesics.
A brief overview of current research into local anaesthesia which outlines the potential developments in this field is given as seen from work in one specialised research centre. This is a précis of a paper given as the second Goldman Lecture.