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Biomedical subjects

J Kugler

Publications and source records attributed to J Kugler.

At least 91 records · Page 5Linked to original sources
PubMed1987

Relaxation, imagery, and neuroimmunomodulation.

Thirty undergraduates screened for high absorption ability were randomly assigned to three conditions. The first condition consisted of relaxation alone (progressive muscle relaxation and focused breathing). The second one combined this same relaxation training with mental imagery of the immune system. The third condition served as an alertness or mild arousal control; in a vigilance task subjects discriminated between tones presented in variable inter-trial intervals. Subjects reported trial levels of tension and daily stress. Before and after the protocols, which lasted about 1 hour, salivary immunoglobulin A (SIgA), cortisol and catecholamines (saliva and plasma), mood states, and power motivation were assessed. Afterwards, subjects doing relaxation alone and with imagery had a higher level of SIgA than did the vigilance task control group, with a large effect size. When the influence of plasma cortisol was controlled, this immune effect size increased by half, mainly by doubling the SIgA level after relaxation alone. SIgA was significantly and negatively correlated with saliva norepinephrine. The saliva and plasma levels for the neuroendocrine variables appear to be independent. Yet some saliva measures (e.g., epinephrine) did correspond highly with other plasma measures (e.g., norepinephrine).

Epinephrine↗
PubMed1986

Clinical aspects of sleep disturbances and sleeping drugs.

Complaints about sleep disturbances are a common every-day problem in the general practitioner's surgery. Only a few patients need a thorough expert examination in a special sleep laboratory. Thanks to EEG, which makes available a continuous record of uninterrupted sleep cycles, knowledge of the physiology of sleep now includes important information about the normal circadian rhythm of waking and sleeping, the alternation of REM and non-REM periods, and the depth of the individual sleep cycles. EEG results are also an important basis for checking the effect of sleeping drugs. Analysis of sleep disturbances is based on the formal distinction between hypersomnia, and hyposomnia and parasomnia. Etiologically, a distinction must be made between exogenic and endogenic sleep disturbances and attention given to the fact that disturbances of night sleep also affect vigilance on the following day. These considerations are also important for the use of sleeping drugs, whose half-life and biological effect allow a useful differentiation between substances giving impulses to sleep, sleep-inducing drugs, and those enabling uninterrupted sleep during night-time. Sleep disturbances combined with certain other symptoms belong to particular syndromes in which it may be necessary to use sleeping drugs, but these should only be used in combination with other drugs, in order to reduce the risk of side effects, tolerance changes, dependence and addiction with long-term treatment. When a combination of different drugs is given, interference through interaction with lipid or protein binding, and induction or enzyme breakdown in the liver should be taken into account.

Circadian Rhythm↗
PubMed1984

[Nicergoline and cerebral performance insufficiency. Observations in 1 year treatment controls].

In 1,366 patients the effect of Nicergoline (Sermion) on symptoms was recorded for one year. Individual symptoms improved to varying degrees in the patients observed. Many influences were responsible for the recorded improvement in the condition of the patients. These included, apart from the selection, placebo effects, the effect of suggestion, increased personal attention due to the need for monitoring examinations, and the pharmacodynamic effects of the active substance. The fact that the improvement rate of several symptoms such as lack of concentration, impairment of memory, decrease in alertness, dizziness and noises in the ear was analogous to that found in placebo-controlled doubleblind studies of other workers permits the assumption, that not so much the effects of placebo and suggestion but above all the pharmacodynamics of the active substance was the important factor. Treatment, which lasted for a year resulted in an improvement in some symptoms even during the second half of the year but not in others. This provides information on the indication for long-term treatment. Analysis of the individual parameters throws light on the reliability of the information provided by the examining physician, the patient compliance and the psychological effects of the physician's activities. Parameterized values are sometimes recorded more reliably by interested auxiliary medical staff than by physicians who feel alienated from their proper duty by such technical tasks.

Aged↗
PubMed1984

Cardiac rhythm after the Mustard operation for complete transposition of the great arteries.

The Mustard operation corrects the effects of congenital transposition of the great arteries by creating an intraarterial baffle to direct pulmonary venous blood to the tricuspid orifice and systemic venous blood to the mitral orifice. To identify the long-term effects of this procedure, we followed 372 patients with complete transposition of the great arteries who survived the Mustard operation for at least three months. The mean follow-up period was 4.5 years (range, 0.4 to 15.9); the mean age at operation was 2.0 years. Mean resting heart rates were consistently lower than those for age-matched normal children. Seventy-six per cent of the patients had sinus rhythm during the year of operation--a figure that decreased to 57 per cent by the end of the eighth postoperative year. Twenty-five patients died during the follow-up period, nine suddenly. Life-table analysis revealed a cumulative survival rate of 91 per cent for 11 years and 71 per cent for 15 years after the operation. No strong risk factor for sudden unexpected death identified. This study demonstrates that extended survival among patients with transposition can be expected after the Mustard operation. However, over time there is a decreasing prevalence of normal sinus rhythm in survivors, as well as a small risk of sudden death.

Actuarial Analysis↗
PubMed1984

[The action of the benzodiazepine antagonist Ro 15-1788].

The benzodiazepine-receptors are close by the GABA-receptors. They are found in all areas of the brain, especially in the area of the cortex. The imidazo-benzodiazepine Ro 15-1788 has a high affinity to the receptor without showing any biological activity. The antagonist Ro 15-1788 cancels the sleeping effect, which was produced by benzodiazepines, within 30-60 s. Deep phases of sleep after 4 mg per 70 kg body weight lormetazepam, a dose which was not in clinical use up to now as well as the sleeping effect of 2 mg flunitrazepam per 70 kg body weight and 10-11 mg midazolam per 70 kg body weight are safely antagonized without adverse reactions. According to pharmacodynamic researches by means of EEG and psychometry the half-life period of the antagonist is shorter (1-2 h) than that of the agonist. The clinical application of the antagonist Ro 15-1788 (in patients) is at hand. The control of benzodiazepine-N2O/O2-anaesthesia seems to be guaranteed with the introduction of the antagonist for clinical use.

Anesthesia↗
PubMed1984

[Vigilance--its EEG determination].

The definition of vigilance was based primarily on criteria of overt behaviour and concomitant electrographic patterns of functional states as well as on psychometrically tested performance. It turned out that the combination of well defined electroencephalographic activity patterns is an utile and reliable measure for the classification of different vigilance levels, even when there is no experimental testing of performance possible or the observation of behaviour misleading. We know today defined mixtures of characteristic regional EEG activities for the estimation on different levels of vigilance between supervigilance and subvigilance. There are however also deviations from regularly observed combinations of signs with dissociations between behaviour, performance and EEG-activity patterns. For the theory of vigilance one can use the analyses of topological and chronological organization of EEG-activities as starting point. Not only characteristic frequency mixtures are correlated with given vigilance levels; moreover the diffusion of regional activities interfering with all other regional activities builds up the socalled "vigilance profile". This profile varies with time slowly or quickly. The regular topological process distribution of activities is commonly the expression of a dominating mental process interfering with other submental processes. The chronological variations of vigilance profiles show their dynamism with transitions from fixed, strictly bound interest or "concentration" on selected objects to freely fluctuating interest, rapidly jumping from object to the other.

Alpha Rhythm↗
PubMed1983

Acute inotropic stimulation with dopamine in severe congestive heart failure: beneficial hemodynamic effect at rest but not during maximal exercise.

Hemodynamic and metabolic effects of dopamine were studied at rest and during maximal exercise in 13 patients with severe chronic congestive heart failure (CHF). During exercise before the administration of dopamine, the stroke volume index increased from 17.1 +/- 5.2 ml/m2 at rest to 28.1 +/- 10.9 ml/m2 (p less than 0.001) at exhaustion, while pulmonary capillary wedge (PCW) pressure increased from 22.7 +/- 12.7 to 43.9 +/- 11.9 mm Hg (p less than 0.001). The arteriovenous oxygen difference increased from 8.9 +/- 2.3 ml/100 ml to 12.4 +/- 2.0 ml/100 ml (p less than 0.001) and oxygen uptake increased from 3.5 +/- 0.6 0.6 to 11.9 +/- 2.5 ml/kg/min (p less than 0.001). At rest, dopamine increased the stroke volume index to 23.3 +/- 8.1 ml/m2 (p less than 0.001) and reduced the PCW pressure to 20.5 +/- 1.1 mm Hg (p less than 0.05). However, during maximal exercise, the stroke volume index and PCW pressure were not changed by dopamine: 28.1 +/- 10.9 versus 28.6 +/- 10.2 ml/m2 (difference not significant [NS]) and 43.9 +/- 11.9 versus 42.5 +/- 11.2 mm Hg (NS), respectively. In contrast, the maximal heart rate achieved during exercise was significantly higher with dopamine, 140.3 +/- 29.3 versus 136.0 +/- 29.7 beats/min (p less than 0.05), which contributed to a slight augmentation in the maximal cardiac index, 3.82 +/- 1.13 versus 3.64 +/- 1.17 liters/min/m2 (p less than 0.05). Nonetheless, neither peak arteriovenous oxygen difference nor maximal oxygen uptake were significantly changed by dopamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

Comparative hemodynamic effect of metrizamide and Renografin 76 in infants with congenital heart disease.

Twenty patients under the age of 2 years with suspected congenital heart disease received alternately Renografin 76 and metrizamide for angiocardiography. The dose was 2.0 ml/kg per injection for both contrast media into the left ventricle. Metrizamide induced slightly lesser change in heart rate, peak systolic pressure, and peak end-diastolic pressures. Serum osmolality, hematocrit, and serum electrolytes were affected equally by the contrast media. Metrizamide was well tolerated by the neonates with congenital heart disease and its radiopacity was adequate for diagnostic purposes. At the doses administered, metrizamide does not seem to have any great advantage over Renografin 76 for angiocardiography in infants with severe congenital heart disease.

Angiocardiography↗
PubMed1983

[Difference between the effects of 2 galenically different oxazepam formulations on the EEG].

A clinical-experimental investigation was carried out in 14 healthy male test-subjects, according to a randomized double-blind cross-over design, in which the sedative and tranquillizing effects of two different oxazepam formulations were studied, with EEG examinations and psychometric tests. An adequate effect was observed with both formulations, with the same oxazepam dose. There were slight differences in the drug-EEG profiles, indicating a more rapid onset of action and a somewhat longer-lasting effect of oxazepam (Sigacalm) up to the 6th h after ingestion, in comparison with the standard form. Neither formulation leads to any psychometrically measurable loss of performance, but slight differences are observed in the increased performance induced by exercise: from the 2nd to the 6th h after ingestion it is slightly less with the trial preparation than with the standard form. Side effects were observed with neither formulation. The differences in the EEG quantification after administration o the two products are probably due to differences in the absorption and distribution of the two different galenical formulations.

Adult↗
PubMed1982

Variable clinical response to long-term angiotensin inhibition in severe heart failure: demonstration of additive benefits of alpha-receptor blockade.

The effects of long-term therapy with captopril (CPT) were studied in 11 patients with severe chronic congestive heart failure (CHF). At initiation of therapy, cardiac index increased from 1.88 +/- 0.56 to 2.12 +/- L/min/m2 (p less than 0.05), while pulmonary capillary wedge pressure decreased from 27.9 +/- 7.2 to 17.8 +/- 7.6 mm Hg (p less than 0.01). This improvement in resting cardiac performance was maintained during maximal exercise; however, maximal oxygen uptake was not acutely increased by CPT. During chronic therapy, 6 of 11 patients showed symptomatic improvements; however, only three of these six patients demonstrated an increase in maximal oxygen uptake, which was measured at an average of 13.2 weeks following initiation of therapy. Five patients did not improve clinically during chronic therapy. In these patients, hemodynamic measurements that had improved initially after CPT returned to baseline values during chronic therapy. The addition of prazosin to chronic CPT therapy elicited a beneficial hemodynamic response in all five patients. Thus, the results of long-term therapy with CPT are variable in patients with severe CHF, and symptomatic improvement does not always correlate with objective measurement of exercise capacity. Combined alpha-adrenergic blockade and angiotensin-converting enzyme inhibition appears safe in patients who failed to exhibit a sustained improvement on CPT alone.

Adrenergic beta-Antagonists↗
PubMed1982

Plasma concentration and E.E.G. after various regimens of etomidate.

Etomidate was injected i.v. within 10 or 60 s at various doses. After etomidate 0.3 mg kg-1 the plasma concentration was 1.6 micrograms ml-1 at 1 min after the end of injection. For about 7 min a good hypnotic effect (stages C0-D2) was observed on the e.e.g. recording. For surgical procedures, however, a combination with analgesic drugs appeared to be necessary. When the dose of etomidate was increased (0.1-0.4 mg kg-1) a linear increase in plasma concentration and slow e.e.g. activity was observed concomitantly. Anaesthesia could be prolonged with additional injections or with continuous infusion. Each additional injection produced a steep increase in concentration of short duration with marked deepening of hypnosis. The infusion induced only a moderate increase in plasma concentration, whereas the depth of sleep during the period of infusion remained nearly the same. E.e.g. changes induced by etomidate are similar to those after barbiturates and other i.v. anaesthetics.

Adult↗
PubMed1982

Regional and systemic metabolic effects of angiotensin-converting enzyme inhibition during exercise in patients with severe heart failure.

The acute hemodynamic and metabolic effects of captopril therapy were studied in 12 patients with severe heart failure during maximal exercise performed on an upright bicycle ergometer. During the control period, exhaustion occurred after 4.2 +/- 2.7 minutes of exercise. Cardiac index increased from 1.54 +/- 0.36 l/min/m2 at rest to 3.39 +/- 1.54 l/min/m2 (p less than 0.001) at exhaustion; systemic arteriovenous oxygen difference increased from 8.8 +/- 2.1 to 12.8 +/0 2.4 ml/100 ml (p less than 0.001) and oxygen uptake from 3.4 +/- 0.5 to 10.8 +/- 3.0 ml/kg/min (p less than 0.001). Pulmonary arterial oxygen content decreased from 7.3 +/- 1.3 to 3.7 +/- 1.5 ml/100 ml (p less than 0.001) and femoral vein oxygen content from 5.0 +/- 1.7 to 2.5 +/- 1.2 ml/100 ml (p less than 0.001). During captopril therapy, cardiac index significantly increased both at rest (1.83 +/- 0.54 vs 1.54 +/- 0.36 l/min/m2, p less than 0.01) and during maximal exercise (3.67 +/- 1.51 vs 3.39 +/- 1.54 l/min/m2, p less than 0.01). Systemic arteriovenous oxygen difference decreased significantly at rest, from 8.8 +/- 2.1 to 7.7 +/- 2.1 ml/100 ml (p less than 0.01) and during maximal exercise from 12.8 +/- 2.4 to 12.3 +/- 2.2 ml/100 ml (p less than 0.01). Pulmonary arterial oxygen content at exhaustion was significantly higher during captopril therapy than during the control period (4.1 +/- 1.1 vs 3.7 +/- 1.5 ml/100 ml, p less than 0.05), while femoral venous blood content was unchanged. Captopril therapy did not significantly increase maximal oxygen uptake or exercise duration. Thus, the acute administration of captopril to patients with severe heart failure does not increase exercise capacity despite improved cardiac performance. Moreover, captopril therapy does not acutely result in metabolic benefits to the skeletal muscles during exercise.

Administration, Oral↗