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Biomedical subjects

K Kellner

Publications and source records attributed to K Kellner.

13 recordsLinked to original sources
PubMed1992

Combined high-efficiency hemodialysis and charcoal hemoperfusion in severe N-acetylprocainamide intoxication.

Several extracorporeal techniques have been used to remove N-acetylprocainamide (NAPA), the major metabolite of procainamide, in patients intoxicated with this substance. We report a patient with life-threatening NAPA intoxication who was rapidly and successfully treated with combined high-efficiency hemodialysis and charcoal hemoperfusion. The hemodialyzer and hemoperfusion cartridge were placed in series such that the patient's blood was dialyzed before reaching the cartridge. Overall clearance of NAPA was 153 mL/min, with clearance due to hemodialysis averaging 102 mL/min and that due to hemoperfusion averaging 88 mL/min. Thus, addition of the hemoperfusion cartridge into the extracorporeal circuit resulted in a 50% increase in clearance over that obtainable by high-efficiency hemodialysis alone. In comparison to other modalities, this technique is more effective than either hemodialysis or charcoal hemoperfusion alone and can achieve a more rapid reduction of serum NAPA levels than that observed with slow continuous hemofiltration or hemodiafiltration.

Acecainide↗
PubMed1990

[The effect of verapamil on adrenocortical hormone secretion].

Variations in circadian cortisol rhythm, morning ACTH concentration and the 24-hour cortisol excretion were examined in 15 healthy volunteers and 9 untreated patients with cardiovascular diseases. These variations were measured under basal conditions and during low dose (ACTHL-test) and also a high dose (ACTHH-test) ACTH stimulation. Additionally, in the patients with cardiovascular diseases the effect of verapamil-administration was investigated. Under basal conditions no significant differences were to be seen between normal subjects and the patients, either before or after therapy. The two functional tests resulted in almost identical increases of cortisol and ACTH levels, both in healthy subjects and the patients before verapamil. It was found that after verapamil application during the ACTHL-test, the levels of plasma cortisol decreased in comparison with the values noted before verapamil (p less than 0.05). However, in the ACTHH-test a significant increase of the plasma cortisol (p less than 0.05) was evident. Our results lead to the conclusion that after verapamil therapy, under slight loading, the plasma cortisol concentration can be expected to decrease slightly, and in extremely high stress situations it will increase.

Adrenocorticotropic Hormone↗
PubMed1990

[Does the calcium antagonist verapamil modify calcium metabolism?].

In 11 healthy volunteers the effects of oral verapamil administration (4 X 80 mg/d) on plasma or serum concentrations of ionized, pH-corrected ionized and total calcium, on intact and midregional parathyroid hormone and on 24 h urinary excretion of calcium were investigated at rest. In addition the concentrations of ionized, pH-corrected ionized and total serum calcium were analyzed under bicycle exercise. Verapamil resulted in an increase of total serum calcium (p less than 0.02) and a fall in midregional parathyroid hormone concentrations (p less than 0.02) at rest. There was also found a statistically significant elevation of both ionized (p less than 0.05) and pH-corrected ionized (p less than 0.05) plasma calcium, and a slight increase in the total calcium under exercise (p less than 0.1). Before verapamil a significant negative correlation between total calcium and midregional parathyroid hormone was evident (r = -0.618; p less than 0.05), which however could not be clearly discerned after verapamil.

Adult↗
PubMed1989

[Verapamil in primary hyperparathyroidism].

In a female patient with primary hyperparathyroidism and disturbances of cardiovascular function clinical, biochemical and electrocardiographic as well as bone scintigraphic parameters were analyzed before and during therapy with verapamil (Falicard) for 7 month. Verapamil therapy resulted in decrease of the frequency of the supraventricular tachycardia, and, in higher doses (4 X 120 mg), also reduction of blood pressure, however, with dose limiting bradycardia and prolongation of PQ-time. Both the normalization of serum phosphate level, diminution of hypercalcemia of the ionized calcium and the decrease of hypercalciuria and increase of scintigraphic index as an expression of the decrease of high activity of bone metabolism suggest alterations of the calcium homeostasis. Under oral calcium load the constantly increased PTH values markedly could be suppressed indicating an alteration of intracellular parathyroid calcium set point. Discussion is performed with respect to possible protective metabolic and cardiovascular effects of calcium antagonists in this endocrine functional disorder.

Adult↗
PubMed1989

[Hormone changes as indicators of stress in the development and course of myocardial infarct].

The effect of hormonal-metabolic risk factors in the development of various forms of the coronary heart disease is included into a concept of stress. After demonstration of the historical development of the stress research on the further developed basis of the general adaptation syndrome of Selye the adrenocortical system is used for the evaluation of stressors. Thereby the hormonal characteristics of the behaviour of type A which is at risk of an infarction after Friedman and Rosenman are described. The hormonal-metabolic adaptation of the organism to psychosomatic stressors is demonstrated for the acute phase and the chronic phase. In the acute phase the corticol level correlates with the clinical course of the infarction as well as with the haemodynamic parameters PAEDP and heart index. Cortisol is regarded as parameter of the postaggression metabolism. The increased cortisol level dependent upon time in its course leads to the low-T3-syndrome and to the decrease of testosterone. From this result secondarily effective modifications of the metabolism which are above all valuated as defence reactions. In the chronic phase of risk the values of cortisol are lowered in the stress response. This low cortisol response is a functional maladaptation, which according to our retrospective study is prognostically favourable. A therapeutic influence on the adrenocortical function by calcium antagonists is effective, but up to now not yet sufficiently proved.

Adrenocorticotropic Hormone↗
PubMed1989

[Hyperthyroidism and its relation to heart function].

The influence of hyperthyreosis on the cardiac function was investigated by means of non-invasive methods (radiocardiography, echocardiography, Tc-99m- und Tl-201-scintigraphy of the myocardium) and invasive methods (coronary angiography). Independent of age an increase of the frequency was always existing, a significant increase of the filling of the ventricle, of SI and HI was shown only by younger patients. With the help of the echocardiography local and global disturbances of kinetics, by means of the Tl-201-scintigraphy of the myocardium disturbances of the myocardial perfusion could be proved. For the circulating plasma catecholamines noradrenalin, adrenalin and dopamine values were established lying in the lower region of the normal. The effects of an increase of the thyroid hormone on the number and/or sensitivity of the membrane-bound beta-adrenoceptors of the heart as well as the independent of its effect of the SDH on the obtaining of myocardial energy are discussed.

Adolescent↗
PubMed1985

[Gonadal and adrenocortical hormone changes in myocardial infarct].

On a male group of patients investigations of the behaviour of the testosterone, LH, cortisol and ACTH serum concentrations in the hospital phase of the acute myocardial infarction were carried out. Apart from an early activation of the adreno-cortico-pituitary axis a decrease of the testosterone concentrations at consistent LH levels was observed. On healthy test persons in the ACTH and hydrocortisone tolerance test possible interactions between adrenocortical and gonadal hormone system were controlled.

Adrenocorticotropic Hormone↗
PubMed1979

[Various mechanisms of disorders of carbohydrate metabolism in myocardial infarct].

A group of 112 patients with acute myocardial infarction was studied. Methods for determining the content of immunoreactive insulin, uric acid, triglycerides, and sugar in blood on a fasting stomach and under conditions of carbohydrate load in dynamics were used. The data obtained show that patients, mainly those with uncomplicated myocardial infarction, are marked by relative insulin insufficiency as well as by a high level of triglycerides and uric acid in the acute period of the disease. The causal relationship between hyperuricemia, hypertriglyceridemia, and carbohydrate metabolism disorders is discussed.

Acute Disease↗
PubMed1979

[Psychosomatic medicine in intensive care units (author's transl)].

Psychosomatic medicine in intensive care units is essentially characterized by problems arising from the emotional involvement of the intensive care unit team. That is why the functions of a psychosomaticist are not only the diagnostics of psychosyndromes and the psychotherapy of dangerously ill patients, but especially the study of psychological interrelations within the unit team. Hypochondriac depressive psychosyndromes caused by the experience of dread, confusion, exhaustion and communication problems, as well as psychosyndromes characterized by a reduction of consciousness and orientation are discussed. Anaclitic psychotherapy, i.e. supporting and encouraging care, and emergency psychotherapy actually required in precarious situations, are described. The specific interrelations within and between the individual groups of the intensive care unit team (physicians, female and male nurses), which are important to the working conditions in the unit, and the possibilities of their psychological activation (e. g. in Balint groups) are outlined. The status and responsibility of a psychosomaticist within the unit team is critically reflected. Finally, the permanent confrontation of the team with death and dying is emphasized, and the psychological aspect of discontinuing intensive care is discussed.

Adjustment Disorders↗
PubMed1979

[Interaction between intensive care patients; a comparison of different intensive care units (author's transl)].

A study was made of the extent and type of contact which patients of an intensive care unit established with each other. The information was obtained by interviewing 92 patients in 4 different types of intensive care units. In evaluating and interpreting the results special attention was paid to the possible influence of 10 patient-specific and disease-specific parameters. 81 per cent of the interviewed persons had established contact, mostly of a verbal nature, with their fellow patients. The majority appreciated the companionship and attached a positive value to the contacts made: communication with the other patients relieved the mental stress arising from their condition and detracted from their anxiety and tendency to brooding; on the other hand, they were also, to some extent, worried that too much excitement might adversely affect their condition. Encouraging talks by the medical team greatly helped towards reducing stress. Even severely ill persons who could no longer actively communicate felt happier in a multi-bed ward: they felt less isolated and more involved and therefore, psychically supported. The fact that the great majority of patients preferred multi-bed units to single rooms suggests that the former have a stabilizing effect, both physically and psychically - an aspect of intensive care that has so far been ignored.

Bed Occupancy↗
PubMed1977

[Tracer kinetic studies of the cholesterol metabolism in patients with hypercholesterolemia].

For the examination of the cholesterol metabolism in patients with normal and increased serum cholesterol the 3H-cholesterol was used. The tracer-kinetic investigation programme consisted of the examination of the serum for free and esterified cholesterol as well as the separation in VLDL-, LDL- AND HDL-fractions. The establishment of the content of radioactivity of the individual samples was carried out in the LSC-nitrobeta 1210. Specific activity-time-curves were established and fitted according to a mathematical programme. The most essential findings of the evaluation of these curves resulted in a clearly changed turnover of the LDL-fraction. Possible causes for the disturbed LDL-turnover were discussed.

Cholesterol↗
PubMed1976

[Comparative studies of the psychosomatic aspects of liver diseases].

Connections between disturbed functions of liver and mental diseases at all times have been generally supposed as existent and have been discussed in the literature; they should be clarified by means of questionnaire-tests: MPI-test and MMQ-test of Eysenck combined with neurotizism-depression-questionnaire of Hoffmann-La Roche allowed to comprehend the dimensions of personality "neurotizism" and "depressivity". Concerning "neurotizism" statistically significant differences could be found between liver-patients and healthy persons in a tendency to a significant increase among liver-patients, but not between liver-patients with other diseases. The tendency to "depressivity" of healthy persons could be statistically evaluated as being much greater than that of liver-patients; there were no differences between liver-patients and patients with other diseases. That is why liver-patients do not differ psychically from patients suffering from other diseases; they share their reaction to the occurrence of disease - in various degrees until a neurotic lack of active realization of the fact of illness. Liver-diseases apparently are not triggered or caused by special pre-morbid alterations.

Depression↗