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Biomedical subjects

H Gerlach

Publications and source records attributed to H Gerlach.

At least 109 records · Page 6Linked to original sources
PubMed1987

[Opinion of mothers on continuous peridural obstetrical anesthesia].

The general opinion on epidural anesthesia in obstetrics may be adversely affected by recent public controversies about the mother's situation during childbirth in hospital, which nowadays is often considered to be a highly technological, impersonal, or "unnatural" procedure. This assumption led us to conduct an inquiry on maternal assessment of obstetric epidural anesthesia and its relation to the clinical and social history. The study included 113 parturients, who received epidural anesthesia (on-demand epidural injections of bupivacaine 0.25%) for vaginal delivery. Mothers were asked to answer certain questions about this regimen (e.g. analgetic efficacy; difficulties in deciding on this method; recommendations to other parturients; opinion of the role of epidural anesthesia in obstetrics; choice of analgesic regimen for future childbirth) 1 day after delivery and 2 months later. Additional social and historical factors (e.g. education; profession; family status; preceding pregnancy, childbirth or abortion; complications during pregnancy or childbirth; duration of parturition) were used to reveal relevant statistical correlations. Sixty-five percent of the patients considered pain relief by epidural anesthesia as "good" or even "very good" during the first inquiry immediately after childbirth. Women who had undergone prior interruptions of pregnancy were less satisfied, probably because of their rather ambiguous attitude towards motherhood. With regard to the choice of analgesic regimen for future childbirth (50% of the patients had made a definite decision to have epidural anesthesia under this condition), those women were especially reserved who had suffered from complications during pregnancy and disapproved of it in the future.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Epidural↗
PubMed1986

[Spasticity treatment with spinal morphine or midazolam. In vitro experiments, animal studies and clinical studies on compatibility and effectiveness].

Recent pharmacological investigations have support the hypothesis that spinal modulation of nociception as well as motor coordination is related to the activity of spinal interneurons and that certain spinal transmitters are involved in the control of both regulatory systems. Opioids and benzodiazepines, i.e. endorphin- or GABA-induced mechanisms, may be of importance for spinal treatment of spasticity in the near future. In order to clinically evaluate the interactions of these spinal processes we performed in vitro-experiments, animal studies and clinical investigations on the compatibility and antispastic efficacy of spinally administered opiates and benzodiazepines. Preclinical studies on tissue- and CSF-tolerance of different benzodiazepines (pH, tonometry, turbidimetry, histological findings in animals) are in favour of midazolam, a water-soluble compound, which is active against pharmacologically induced spasms in animals (strychnine application in cats with chronical catheterization of the subarachnoid space) after lumbar intrathecal injection. Using an appropriate dosage of intrathecal midazolam selective blockade of spasticity of the hind legs may be demonstrated with integrated EMG. Clinical investigations (neurological assessment using rating scores for spasticity) in 16 patients, including a double-blind comparison of epidural morphine or midazolam, indicate that both drugs are effective against spinal spasticity of different origin. Efficacy of spinally applied agents depends on the severity of spasms and on the duration and extent of systemic pretreatment.

Animals↗
PubMed1986

[Intra- and postoperative interactions between the 2 opioids fentanyl and buprenorphine].

In order to demonstrate pharmacokinetic and pharmacodynamic interactions between fentanyl and buprenorphine, 3 groups of patients (n = 30) were compared, receiving either fentanyl (0.005 mg/kg b.w.) or buprenorphine (0.01 mg/kg b.w.) or both opioids as analgesic during surgery for disc protrusion. For a period of 4 h haemodynamic parameters were monitored and blood samples were taken for determination of the following concentrations: ADH, ACTH, cortisol, glucose, unbound glycerol, fentanyl and buprenorphine. Blood gas analyses were performed up to 2 h postoperatively. Although in all groups haemodynamic parameters were constant, there was an increase in factors related to operative stress (cortisol, glucose, unbound glycerol, postoperative acidosis) after the combination of both opioids, while postoperative ventilatory parameters in this group were not improved by the partial agonist buprenorphine. Plasma levels were not affected by combined application, except for a slight elevation of buprenorphine concentrations during additional use of fentanyl. Buprenorphine, at least in higher dosages, seems to antagonize analgesia induced by fentanyl, although respiratory depression is even more pronounced. It may be assumed, that with partial agonists the relation of agonistic and antagonistic activity may be different, depending on the dosage used and on the respective pharmacologic effect observed during investigation.

Acid-Base Equilibrium↗
PubMed1985

[Diencephalic pilocytic astrocytoma with clinical onset in infancy. Biological behavior and pathomorphological findings in 11 children].

Pilocytic astrocytomas of the diencephalon with onset of signs and symptoms during the first year of life are reported in 7 boys and 5 girls. Failure to thrive was the initial manifestation in 5 infants. In 2 of them a Russel syndrome emerged. The growth rate of the tumors was slow. One child survived without treatment for 2.5 years. The survival time of the treated children ranged from 7 months to 6 years and 4 months. All children died. No obvious indications of neurofibromatosis were found. All tumors infiltrated and destroyed the hypothalamus. In addition, the tumor infiltrated the optic chiasm in 3 cases and extended into the optic nerves in 2 of them. Most of the astrocytomas were large. Their maximal diameter exceeded 10 cm in 2 children. All were pilocytic astrocytomas grade 1. The grade of malignancy was the same in recurrences as in the initial operative material. Rosenthal fibres were uncommon. It is concluded that diencephalic pilocytic astrocytomas biologically and morphologically resemble most of the pilocytic astrocytomas occurring in early life in other parts of the brain. There is, therefore, no justification for regarding them as a separate tumor entity.

Astrocytoma↗
PubMed1985

[Effects of nitrous oxide and halothane on somatosensory evoked potentials after stimulation of the median nerve].

In 10 healthy adult subjects cervical and cortical somatosensory evoked responses (SEP) after median nerve stimulation were recorded. The recordings were performed before and after inhalation of 66 2/3% nitrous oxide (and 33 1/3% oxygen) and during additional inhalation of halothane in concentrations ranging from 0,5 to 2,0 vol%; end tidal paCO2 and tympanic membrane temperature were kept constant. Nitrous oxide caused a 50% amplitude reduction of the cortical responses while latencies remained unchanged. Latency of the primary cortical response N20 and central conduction time increased continuously with increasing halothane concentration, amplitude N20P25 and amplitude ratio R showed a further decrease. The sensitivity of SEP components to halothane anaesthesia increased with peak latency: Cervical SEP remained relatively constant even during deep anaesthesia, early cortical potentials showed latency prolongation and amplitude reduction, middle and long latency components were progressively diminished with increasing halothane concentration. These changes have to be considered, when interpreting cervical and cortical SEP recorded intraoperatively.

Adolescent↗
PubMed1984

Primary central nervous system tumors in stillborns and infants. Epidemiological considerations.

An epidemiologic investigation of true neoplasms of the central nervous system in fetuses and infants in the German Democratic Republic (GDR) was undertaken. Since all fetal deaths and all deaths in the first year of life are subject to a full postmortem examination and since all cancer cases or deaths are reported to a central registry, the prerequisites for a valid assessment of the incidence of these tumors are present. During the years 1960-1979, 55 histopathologically verified tumors of the central nervous system were identified in the GDR, a frequency of approximately 1.1 per 100 000 births. Unexpectedly, medulloblastoma (13 cases) was the most frequent tumor type.

Brain Neoplasms↗
PubMed1984

Mycoplasma gallisepticum isolation in layers.

Mycoplasma gallisepticum (MG) isolations in live chickens have been made from swabs obtained primarily from the trachea or nasal exudates. As tracheal swabs are often contaminated with feed and because tracheal swabbing may be stressful to the bird, this study was conducted to determine if swabs from the choanal cleft (palatine fissure) would yield MG isolation rates comparable to MG isolation rates of swabs taken from the trachea. Commercial Leghorns from 17 to 22 weeks of age were inoculated via eyedrop with the F strain of MG. Swabs were made from the trachea or the choanal cleft region (palatine fissure) when the chickens were 58 to 63 weeks of age; MG was isolated from 15 of 101 tracheal swab samples and from 51 of 108 choanal cleft swab samples. This study indicates that swabs taken from the choanal cleft region yield higher isolation rates and are more easily obtained than tracheal swabs.

Age Factors↗
PubMed1984

[Primary intracranial tumors as cause of death in the fetus and infant].

Clinical and pathomorphological findings in 2 stillborn and 15 lifeborn children with primary intracranial tumors are reported. All infants died within the first year of life and the tumors were confirmed histologically. In 6 children the tumors (3 intracranial teratomas, 1 glioblastoma, 1 hemangioblastoma, 1 choroid plexus papilloma) were present at birth. All 6 were born with pathologically enlarged heads. Another child exhibited symptoms of brain tumor at the age of three weeks. The tumor was probably present at birth as well. In the remaining infants the signs and symptoms of tumor development became evident some months after birth. These tumors might have occurred postnatally. In a girl aged 9 months, a nephroblastoma of the right kidney and a malignant cerebral tumor, probably a glioma, were present. An incidental coexistence of both tumors is considered, however, a common etiology cannot be excluded. 8 of the 17 intracranial tumors were supratentorially situated. This supports the view that the proportion of supratentorial tumors is higher in early life than in older children.

Adolescent↗
PubMed1984

[Diagnostic and prognostic significance of hemodynamic and respiratory parameters in venous air embolism].

In 25 patients undergoing neurosurgical operations in the sitting position we investigated the reliability of different continuously monitored haemodynamic and respiratory data for hypoxia, which is the most important alteration for the prognosis of air embolism. Simply referring to characteristic changes of end-tidal carbon dioxide (pCO2E) we were able to establish the diagnosis of venous air emboli in 12 of these patients. Besides a decrease in pCO2E, only the reduction of arterial oxygen concentration was statistically significant. Using a simple regression-test, however, no sufficient correlation between the two parameters could be found. Including pCO2E and haemodynamic data in our statistical comparison, multiple regression revealed an optimal correlation with the decrease in arterial pO2. Pathophysiological effects of air embolism are due to a transient accumulation of air in the pulmonary arterioles. Continuous monitoring of pCO2E is the most direct and therefore most reliable method for detection of pulmonary air emboli. Hypoxia, prognostically the most decisive alteration, develops parallel to the decrease in pCO2E and, being of multifactorial aetiology, is also influenced by haemodynamic effects of air embolism.

Carbon Dioxide↗
PubMed1984

[IgM/kappa-immunoblastoma of the brain following Hodgkin's disease. Report on a clinical case and review of literature].

Report of a 41-year-old man who died from an intracerebrally localized pleomorphic IgM/kappa immunoblastoma 7 1/4 years after the diagnosis of nodular sclerosis in mediastinal lymph nodes and treatment by surgery, radiation and cytostatics. There was no evidence of residual Hodgkin's disease at autopsy. The cases of malignant non-Hodgkin's lymphomas after treated Hodgkin's disease reported in the literature are tabulated. The relationship of these secondary neoplasms to the primary disease and its treatment is discussed.

Adult↗
PubMed1984

[A case of anaphylactoid reaction following administration of etomidate].

After injection of etomidate during surgery for herniation of an intervertebral disk an anaphylactoid reaction occurred. Generalized erythema, severe urticaria, and rise in heart rate and blood pressure drop were observed. After treatment with an antihistaminic and a corticosteroid the phenomenons completely disappeared within 45 minutes.

Alcuronium↗
PubMed1982

[Alexander's disease (author's transl)].

A report on clinical course and morphological findings in a case of Alexander's disease is given in a boy aged 4 year and 6 months. The disease started in the second month with progressive retardation. At the age of 13 months, a ventriculo-peritoneal shunt was performed because of dilatation of ventricles. Death occurred due to cerebral dysfunction. Microscopic investigation showed a considerable demyelination and the presence of numerous Rosenthal fibers. The results are compared with observations in the literature of Alexander's disease during early infancy.

Autopsy↗
PubMed1982

[CNS tumors of the perinatal period (author's transl)].

23.4% of CNS tumors which occur during the first year of life show a close time relationship to the perinatal period. These tumors are subdivided in 3 groups: neoplasm in stillbirths, those with histological verification in the first week of life, and those with symptoms since the first week of life and later on performed histological investigation. Most of the intracranial tumors are localized supratentorially. Teratomas predominate, their relative frequency decreases with increasing age. 36.2% of the spinal tumors in infancy are time-related to the perinatal period, most of them are lipomas.

Autopsy↗