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Biomedical subjects

M Winkler

Publications and source records attributed to M Winkler.

At least 217 records · Page 12Linked to original sources
PubMed1990

Anaesthesia in malignant hyperthermia-susceptible patients without dantrolene prophylaxis: a report of 30 cases.

The intra- and postoperative course of 30 anaesthetics in 24 MH-carriers verified by in vitro contracture tests is reported. None of the patients received dantrolene prophylactically and only agents known to be nontriggers were used for anaesthesia. Neither MH-related changes in perioperative heart rates, body temperatures, and CK levels nor any other symptoms of MH were observed. We conclude that the prophylactic use of dantrolene is not necessary in patients suspected to be prone to MH if triggering agents are avoided and the patients are closely monitored.

Adolescent↗
PubMed1990

Systemic dry cow therapy--a preliminary report.

Efficacy of three different treatment regimens in the elimination and prevention of Staphylococcus aureus intramammary infection was studied in 106 dry cow periods. At drying off, norfloxacin nicotinate was given subcutaneously to 44 cows at 10 mg/kg, oxytetracycline-HCl was administered intramuscularly to 18 cows at 20 mg/kg, 500 mg cephapirin benzathine were infused into each udder quarter of 21 cows, and a group of 23 cows served as an untreated control. Number of existing Staphylococcus aureus intramammary infections was reduced only in the norfloxacin nicotinate treatment group. New infection rate appeared lower in the two systemic treatment groups. The percentage of infected quarters remained the same throughout the dry period in the norfloxacin treatment group but number of infected quarters increased by 33 to 85% (significant in the cephapirin group) in the other groups. Minimal inhibitory concentration of the drugs for 57 S. aureus isolates was determined. Isolates were sensitive to norfloxacin and cephapirin and moderately sensitive to oxytetracycline. Results suggest that systemic dry cow therapy using norfloxacin nicotinate, which possesses large distribution volume, long half-life, and is highly active against the pathogen involved, was more effective than the other treatments.

Animals↗
PubMed1990

[Use of blood components in 30 liver transplantations at the Hamburg Eppendorf University Clinic 1984 to 1989].

Among all major organ transplantations, orthotopic liver transplantation (LTX) requires the most extensive blood component support. From 1984 till 1989 we performed 30 LTX procedures on 27 patients. The number of blood components used totalled 1,000 units of packed red cells (RBC), 966 units of fresh-frozen plasma, 246 units of whole blood, 170 units of random-donor platelet-rich plasma and 71 units of platelet concentrates from cell separator. Three retransplantations were performed within 2 days after the first LTX. The lowest use of blood components was registered in patients with hepatoma, the highest in alcoholtoxic cirrhosis. Ten of the 27 patients are still alive.

Blood Transfusion↗
PubMed1990

Anesthesia in malignant hyperthermia susceptible patients.

The intra- and postoperative course of 30 general and 3 regional anesthetics in 27 MH-carriers verified by in vitro contracture tests is reported. None of the patients received dantrolene prophylactically. Disposable tubings were used for ventilation, vaporizers and soda lime were removed. ECG, esophageal temperature, blood pressure, oxygen saturation, and end tidal pCO2 were monitored. Minor tranquilizers were offered for premedication. Fentanyl, thiopentone, nitrous oxide, non depolarizing relaxants, neuromuscular antagonists and naloxone were used. In three patients, surgery was performed during epidural or spinal anesthesia with the use of amide local anesthetics. Neither MH-related changes in perioperative heart rates, body temperatures, and CK levels nor any other symptoms of MH were observed in any patient. The anesthetic techniques used seem to be safe and reliable; the anesthetic management of known MHS patients is discussed in detail.

Adult↗
PubMed1990

Cyclosporine monitoring in liver allograft recipients: two distinct patterns of blood level derangement associated with nephrotoxicity.

The parallel measurement of specific and nonspecific CyA levels by second generation radioimmunoassays based on monoclonal antibodies proved to be an effective procedure to monitor both parent CyA levels and the capacity to eliminate its metabolite. Using this monitoring procedure it could be shown that CyA-associated nephrotoxicity in the early course after liver transplantation is associated with two distinct patterns of blood level derangement. One pattern is characterized by increased parent drug levels, the other by an increased metabolite concentration resulting from severely disturbed CyA metabolite excretion. This raises the possibility that not only the parent drug but also some of its metabolites may exert nephrotoxic effects when present in excessively high concentrations. This finding provided the rationale for a therapeutic CyA-monitoring regimen taking into account both specific and nonspecific measurements. In liver transplant patients monitored according to this regimen and treated with quadruple immunosuppression the incidence and severity of CyA-associated nephrotoxicity was markedly reduced. The metabolite-associated type of nephrotoxicity was only found in patients with severely disturbed liver function.

Creatinine↗
PubMed1990

[Functional changes in the lower urinary tract after irradiation of cervix carcinoma].

104 patients submitted to primary irradiation for cervix carcinoma were examined by means of urodynamic methods of diagnosis in order to investigate the functional changes of the lower urinary tract induced by therapy. 34 patients could be examined prior to therapy, 19 and 12 patients, respectively, were examined six and 18 months on an average after the treatment. Another group of 70 patients had retrospective check-up examinations with average intervals of five and ten years. Hydronephrosis occurred only as a late result after more than six years in 12% of the irradiated women. The incidence of residual urine, significant bacteriuria, and disturbed sensory function of the bladder was not important. All patients were incontinent two years after the irradiation; 60% of the cases of incontinence were due to the bladder and 40% to the urethra. The increase of urgency incontinence is possibly caused by a radiofibrotic reaction of the bladder, as is shown by correspondent cystometric alterations: the bladder tonicity increased, whereas the bladder capacity decreased. These alterations were only partially reversible. The stress incontinence, however, was found already before the treatment. The maximum urethral closing pressure, which often indicates incontinence due to the urethra, was not modified by the irradiation. An increased stress incontinence, probably caused by advanced age, was found only after six years or later. The problems resulting from functional changes should be taken into consideration in the course of post-therapeutic care, i.e. the patients concerned should be given instructions for a regular bladder training.

Brachytherapy↗
PubMed1990

[Cysto-urethroscopy in the diagnosis of stress incontinence].

61 patients with a urinary stress incontinence of different degrees were examined by cysturethroscopy at a bladder volume of 300 ml in supine position and also by lateral urethrocystography in standing position. With increasing subjective stress incontinence, they showed an increasing dilation of the bladder neck in cysturethroscopy and lateral urethrocystography. At the same time the urethral closure pressure at the proximal urethra diminished. These observations offer new possibilities in the diagnosis of urinary stress incontinence.

Cystoscopy↗
PubMed1989

[In vitro virulence of wound infecting staphylococcal isolates from severely burned patients].

The hemolysin and histamine releasing activity of 30 S. aureus strains isolated from third degree burns of heavily burned patients was detected. The culture supernatants (cs) of Staphylococcus aureus isolated during episodes of invasive burn wound infection displayed significantly lower amounts of hemolysin and histamine releasing activity as compared to cs of bacteria isolated when no sign of septicemia was present. In contrast, when washed bacterial cells were analysed, a reversed ratio could be observed. These data clearly indicate that in strains isolated during invasive burn wound infection pathogenicity factors remain attached to the bacterial surface of the staphylococci investigated.

Animals↗
PubMed1989

[Functional forms of prolapse].

234 women were examined via microtransducers both with 100 ml bladder contents in recumbent position and with 300 ml bladder contents in seated position. The types of prolapse or descensus were categorised after modification according to Green. The quotient from the maximal urethral occlusion pressure at rest recorded with 300 ml bladder filling in seated position and 100 ml bladder filling in recumbent position (known as pressure quotient at rest) showed changes dependent on the type of prolapse (Type I: less than or equal to 1, Type II: less than 1, Type III: greater than 1 (n.s.), Type IV: greater than 1). These functional changes can be explained by the stress-dependent dynamics of each individual form of prolapse. An additional combined form was described (Type III) which was found to be a special form both anatomically and functionally.

Female↗
PubMed1989

[The action of ketamine on muscle contractile behavior. In vitro studies on the musculature of subjects susceptible to malignant hyperthermia].

Since ketamine has been incriminated as triggering malignant hyperthermia (MH) [3, 9, 13, 14, 18], but has still been used uneventfully in MH susceptible patients, we performed an in vitro study to examine the safety of ketamine for use in human MH. METHODS. Muscle specimens of 20 patients who had muscle biopsies to diagnose MH were investigated. In every patient diagnostic contracture tests (2 halothane (Hal) and 2 caffeine (Caf) were done according to the protocol established by the European MH group (EMHG). In addition, one test unit for investigating the effect of stepwise increased bath-concentrations of ketamine (5, 10, 20, 60, 120, 240 and 960 mumol/l) and a further one serving as control (no drugs added to the bath) were used. Combined Hal (2 vol%) and Ket (960 mumol/l) tests were performed in 9 patients (4 MHS, 4 MHN, 1 MHEh). Changes in baseline contractures and mechanical twitch tension were evaluated. RESULTS. The diagnostic test showed MHS in 8, MHN in 8 and MHEh in 4 patients. Ketamine did not induce baseline contractures in any of the tests performed. Contractures induced by 2 vol% of halothane in 4 MHS muscles did not change significantly when ketamine was added to the bath (concentration 960 mumol/l). A significant, dose-related decrease in mechanical twitch tension occurred, when ketamine was added to the test. At the highest concentration (960 mumol) twitch tension was reduced by 55%. Twitch tension remained stable in untreated muscles. No significant differences were found between the specimens from MHS, MHN and MHE patients. This reduction in twitch tension was more pronounced in specimens exposed to both halothane (2 vol%) and ketamine (960 mumol/l), resulting in an average decrease of 71%. CONCLUSION. In accordance with Fletcher et al., our results indicate that ketamine - at least in vitro - does not trigger MH. In MHS muscles, ketamine does not augment halothane-induced baseline contractures. The ketamine-induced reduction of mechanical twitch tension in directly stimulated human muscles has not been described before. Analogous findings in frog sartorius muscles can be found in the literature. Whereas the effect of ketamine on indirectly stimulated muscle has been investigated by several authors, the underlying mechanism of ketamine-induced twitch suppression in directly stimulated muscles is not known. Inhibition of calcium release from or accelerated uptake into the sarcoplasmatic reticulum have been reported.

Caffeine↗
PubMed1988

[The so-called resting pressure quotient--the urodynamic equivalent of clinical pelvic floor insufficiency].

The maximum urethral closure pressure ratio (UCPR) was checked in 370 patients by making recordings with 300 ml in the bladder in the sitting position and 100 ml in the supine position. The result was either an increase or a decrease in the UCPR in the 300 ml profile as compared to the 100 ml profile. The "resting pressure quotient" was judged to be positive in the former case and negative in the latter. The resting pressure quotient was found to be dependent on the subjective degree of incontinence: negative resting pressure quotients became more frequent as the degree of incontinence increased, and positive quotients decreased correspondingly. The probability was found to be more than 99.7% that there was a difference in frequency distribution between the group of 138 continent or minimally stress-incontinent patients and the 232 manifestly stress-incontinent women. The resting pressure quotient described here is the measured equivalent of the clinically diagnosed pelvic floor insufficiency. If the stress pressure profile is difficult to evaluate, this quotient can be taken into account in the urodynamic diagnosis. Negative closure pressure quotients suggest urethral incontinence.

Female↗