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P Bischoff

Publications and source records attributed to P Bischoff.

At least 55 records · Page 3Linked to original sources
PubMed1997

[The necessity for perioperative cortisol substitution. Spontaneous and stimulated ACTH and cortisol secretion during unilateral adrenalectomy for renal cell carcinoma].

UNLABELLED: Impaired adrenal function during perioperative stress carries the risk of acute cortisol (Cs) deficiency (Addisonian crisis), which may be critical without Cs supplementation. Thus, with evidence of dysfunction of the adrenal glands perioperative substitution is indicated. However, it is unclear whether unilateral adrenalectomy may attenuate the adrenocorticoid response. Glucocorticosteroids are potent agents with several well-known side effects. The purpose of the present study was to evaluate if routine Cs supplementation is justified and necessary in patients undergoing adrenalectomy during nephrectomy for renal-cell cancer. METHODS: Ten consecutive patients with renal-cell cancer (5 male, 5 female; age 58 +/- 10 years; ASA class I-II) who underwent adrenalectomy with radical nephrectomy were included in this study. None of them had received steroids for at least 5 years prior to the current surgery. Anaesthesia was induced with propofol, fentanyl, and vecuronium and maintained with isoflurane (PetIso: 0.8 +/- 0.3 vol.%) in nitrous oxide (66%) and oxygen. The patients did not receive any Cs treatment perioperatively. Monitoring included heart rate (beats/min), mean arterial pressure (mm Hg), central venous pressure (mm Hg), O2 saturation (%), and body temperature (degrees C, rectal). Plasma analyses included Cs (Cs radioimmunoassay IBL; normal 120-250 ng/ml), adrenocorticotropic hormone (ACTH) (ACTH-II IRMA; normal (10-50 pg/ml), glucose, and electrolytes determined as follows: preoperatively (8 a.m.); 1-6 h (60-min intervals) after surgery; pre-corticotropin-releasing hormone (CRH) (Corticobiss: 2 micrograms/kg i.v.) administration (1st postop. day at 8 a.m. and after 30, 60, 90, and 120 min. The study was completed with plasma analyses on postoperative days 2 and 3 (8 a.m.). RESULTS: None of the patients showed any clinical signs of plasma parameter of adrenal insufficiency due to the unilateral adrenalectomy. Serum levels (median: 25%/75% percentiles) of Cs (maximum [max.]:253 [217/288] ng/ml) and ACTH (max.:347 ([68/405] pg/ml) were elevated above the normal range postoperatively). After intravenous stimulation with CRH (1st postoperative day), Cs (max.:273 [248/310] ng/ml) and ACTH (max.: 107 ([75/275] pg/ml) were also increased above normal. During postoperative days 2 and 3 (8 a.m.) Cs and ACTH remained in the high-normal range. CONCLUSIONS: Data from this study indicate that unilateral adrenalectomy was associated with adequate spontaneous Cs secretion by the remaining adrenal gland. Moreover, stimulation with CRH demonstrated adequate reactivity of the pituitary-adrenal axis. None of the patients showed any signs of Cs deficiency by clinical or serum parameters. Therefore, we do not recommend routine Cs supplementation in patients undergoing adrenalectomy during tumor nephrectomy, nevertheless, Cs supplementation remains necessary for patients with primary hypothalamic-pituitary-adrenal dysfunction (Addison's disease) or hyperfunction (Cushing's disease).

Adrenalectomy↗
PubMed1997

[Liver transplantation in a small center: feasibility, efficacy and prospects].

Today, orthotopic liver transplantation is the treatment of choice for the end-stage of various liver diseases, and a 1-year survival rate of 80% and a 5-year survival rate of 70% in elective patients without tumor are reported in international surveys. The liver transplant programme of the Inselspital in Bern is small compared with international centres, which may raise questions about the results and the justification for such a programme. Over a period of 66 months, 62 liver transplantations were performed in 60 patients at the Inselspital. The hospital mortality was 3.3%, and the 2.5-year overall survival rate was 92% for elective cases without tumor. After a median follow-up of 30 months, 68% of all patients were re-integrated in housework or full- or part-time in their profession, and 83% were independent from the help of others. We conclude that a small liver transplant programme based only on routine resources can achieve results comparable to the international standards.

Academic Medical Centers↗
PubMed1997

Prolonged rewarming after hypothermic cardiopulmonary bypass does not attenuate reduction of jugular bulb oxygen saturation.

OBJECTIVE: This study investigates the effects of rapid versus graded rewarming on decreases in jugular bulb oxygen saturation (SjO2) during cardiopulmonary bypass (CPB) in a prospective nonrandomized and nonblinded design. SETTING AND PARTICIPANTS: At the Department of Anesthesiology (University Hospital Eppendorf, Germany), 28 patients (ASA III) undergoing coronary artery bypass graft were investigated. INTERVENTION: CPB was managed according to alpha-stat conditions during moderate hypothermia (27 degrees C). In group 1 (n = 17), rewarming was performed by increasing the perfusate temperature to 36 degrees C within 7 minutes, in group 2 (n = 11) within 15 minutes. MEASUREMENTS AND MAIN RESULTS: SjO2 was measured by a fiberoptic catheter placed in the right jugular bulb. Data were recorded before and 40 minutes after the start of rewarming every 5 minutes. During rewarming of CPB, SjO2 was decreased to 43 +/- 7% in group 1 and to 44 +/- 4% in group 2. In groups 1 and 2, the maximum reduction of SjO2 occurred 17 minutes and 30 minutes after start of rewarming, respectively. The delayed reduction of SjO2 in group 2 correlated strongly with the prolonged increase in jugular bulb temperature. CONCLUSION: The current data show that slow rewarming does not attenuate reductions of SjO2. This suggests that the reduction of SjO2 during rewarming of CPB is not a function of the rewarming speed but is strongly correlated with the increase in jugular bulb temperature, with a maximum effect just before reaching normothermia of the brain.

Adult↗
PubMed1997

[Intraoperative pain stimuli change somatosensory evoked potentials, but not auditory evoked potentials during isoflurane/nitrous oxide anesthesia].

PURPOSE: Evoked potentials are used for intraoperative monitoring to assess changes of cerebral function. This prospective randomised study assesses the influence of surgical stimulation on midlatency components of somatosensory (SEPs) and auditory evoked potentials (AEPs) in anaesthetised patients. METHODS: After approval of the Ethics Committee and written informed consent 36 orthopaedic patients (34 +/- 15 y, 73 +/- 14 kg. 1.71 +/- 0.07 m, ASA I-II) were randomly included in the study. Anaesthesia was induced with 1.5 micrograms/kg fentanyl, 0.3 mg/kg etomidate and 0.1 mg/kg vecuronium. The lungs were intubated and patients normoventilated in steady state anaesthesia with isoflurane (end-tidal 0.6%) and 66% nitrous oxide. 18 patients (group 1) were assigned to the SEP group: median nerve stimulation, recording at Erb, C 6 and the contralateral somatosensory cortex (N20, P25, N35) vs Fz. AEPs were recorded in group 2 (n = 18): binaural stimulation, recording at Cz versus linked mastoid (V, Na, Pa, Nb). Recordings were performed during 30 min before the start of surgery (baseline: BL), at skin incision (SURG1) and at the preparation of the periost (SURG2). Heart rate, mean arterial blood pressure, oxygen saturation, endtidal pCO2 and isoflurane (PetISO) concentrations were registered simultaneously. Data were analysed by one-way analysis of variance. Post hoc comparison were made by Mann-Whitney U-Wilcoxon Rank Sum Test with p < 0.05 significant. RESULTS AND DISCUSSION: During steady state isoflurane anaesthesia surgical stimulation (SURG2) resulted in significant increases of N20 P25 amplitudes compared with BL (BL: 1.4 +/- 0.7 microV; SURG2: 2.0 +/- 0.8 microV; p < 0.05). Latencies of SEPs and midlatency components of AEPs did not change over time. There were no differences in autonomic parameters between SEP and AEP groups. MAP increased from 76 +/- 6 mmHg at BL to 93 +/- 16 mmHg at SURG1 and 96 +/- 17 mmHg at SURG2 (n = 36; p < 0.05). HR increased from BL (60 +/- 8 beats/min) to SURG2 (76 +/- 12 beats/min). Increases of amplitudes of midlatency SEP amplitudes indicate increased nociceptive signal transmission which is not blunted by isoflurane-nitrous oxide anaesthesia. In contrast, unchanged AEPs indicate adequate levels of the hypnotic components of anaesthesia.

Adult↗
PubMed1997

[The role of angiography in age-related macular degeneration].

Age related macular degeneration (AMD) is a common disease. Angiography with fluorescein and indocyanine green (ICG) respectively is a proven diagnostic tool, which enables to diagnose the disease's different forms. Being an invasive method, it must however be undertaken with clear indications. This overview article is based on the literature available and on own experiences with exudative AMD, studied by simultaneous fluorescein and ICG angiography (using the Rodenstock scanning laser ophthalmoscope). In non-neovascular AMD (drusen, abnormalities and geographic atrophy of the retinal pigment epithelium), angiography may be indicated only in atypical cases in order to allow the correct diagnosis. In exudative AMD (with suspected choroidal neovascularisation (CNV) and/or pigment epithelial detachment), angiography is indicated very early in order to find a treatable lesion. Fluorescence angiography is indicated in AMD in order to find the correct diagnosis in atypical cases and in order to find a potentially treatable lesion in the exudative form.

Aged↗
PubMed1997

Effect of 6(5H)-phenanthridinone, a poly (ADP-ribose)polymerase inhibitor, and ionizing radiation on the growth of cultured lymphoma cells.

The ability of 6(5H)-phenanthridinone (Phen), a new potent poly(ADP-ribose)polymerase (PARP) inhibitor, to potentiate the effect of ionizing radiation on tumour cells was evaluated. RDM4 murine lymphoma cells were irradiated using a 60Co panoramic source and then examined for their growth, cell cycle distribution and apoptosis. Phen (100 microM) was found to inhibit more than 90% of the PARP activity in control and irradiated cells. Cell proliferation was assessed using Alamar Blue, a new fluorometric assay. Phen was found to sharply increase the radiation-induced inhibition of cell proliferation. Indeed, at 2.5 Gy the relative cell number of Phen-treated cells was 60% below control levels. At the same radiation dose, the G2M arrest was also significantly reinforced by the addition of Phen. Furthermore, this PARP inhibitor was shown to significantly increase the amount of DNA fragmentation as revealed by the DNA migration pattern in agarose gel electrophoresis. Comparable results were obtained with 3-aminobenzamide, another PARP inhibitor, but at concentrations 200-fold higher. Taken together, these results indicate the potential interest of Phen as a valuable pharmacological probe for investigating the role of PARP in cellular responses to radiation. They also suggest a possible use of Phen as an adjuvant in radiotherapy.

Animals↗
PubMed1996

Analysis for microsatellite instability and mutations of the DNA mismatch repair gene hMLH1 in familial gastric cancer.

We examined 30 gastric-cancer patients with a varying degree of family history of stomach cancer and/or synchronous gastric tumors for microsatellite instability. We observed microsatellite instability at at least 1 of 8 loci tested in tumors of 14/30 patients; of these 14, 8 had single locus alterations and 6 had alterations at at least half of the 8 loci. Among the patients with microsatellite instability at > or = 4 loci, 3 patients showed a strong familial clustering of gastric cancer. Mutation analysis of the DNA mismatch repair gene hMLHl on paired non-tumorous and tumor DNA from 10 patients, 6 with microsatellite instability at > or = 4 loci and 4 with an alteration at one locus, revealed a novel missense mutation, present in the normal and tumor DNA of one patient with microsatellite instability at multiple loci in his tumor. His family history of cancer included one second-degree relative affected with gastric cancer. These data suggest that germline mutations in the hMLHl gene occur in some gastric-cancer patients and that in the majority of cases microsatellite instability in gastric tumors may be due to defects in other genes responsible for DNA replication fidelity than the hMLHl.

Adaptor Proteins, Signal Transducing↗
PubMed1996

N-acetylcysteine protects lymphocytes from nitrogen mustard-induced apoptosis.

The ability of the antioxidant N-acetylcysteine to prevent apoptosis induced in lymphocytes by nitrogen mustard (HN2) was investigated. HN2 caused a concentration-dependent induction of apoptosis on C3H murine spleen cells, as identified by two criteria: morphological features revealed by microscopical observations and DNA fragmentation visualized by the characteristic "ladder" pattern observed upon agarose gel electrophoresis, as well as by hypodiploid DNA-containing cells revealed by the flow cytometric analysis of propidium iodide labelled cells. The antioxidant N-acetylcysteine (NAC) was found to markedly reduce the occurrence of HN2-induced apoptosis in these cells. This protective effect will still obtained when NAC was added 30 min after HN2. In contrast, the pretreatment of spleen cells with this antioxidant did not provide any significant protection. We also showed that lymphocytes protected by NAC are still able to respond to a mitogenic stimulation. To gain some insight into the mechanisms underlying the cytoprotective action of NAC against HN2, we tested whether or not poly(ADP-ribose) polymerase (PARP, EC 2.4.2.30), a nuclear enzyme that participates in the triggering of apoptosis induced by alkylating agents, is involved. We report that 6(5H)-phenanthridinone, a potent PARP inhibitor, did not affect the ability of NAC to prevent HN2-induced apoptosis under our experimental conditions. Thus, the exact mechanism by which NAC protects lymphocytes from HN2 cytotoxicity has yet to be determined.

Acetylcysteine↗
PubMed1996

Oyxsterols induce membrane procoagulant activity in monocytic THP-1 cells.

Oxidized cholesterol compounds or oxysterols are thought to be potent membrane-destabilizing agents. Anionic phospholipids, chiefly phosphatidylserine, have a procoagulant potential due to their ability to favour the membrane assembly of the characteristic clotting enzyme complexes including the tissue factor-dependent initiating complex. However, in resting cells, phosphatidylserine is sequestered in the inner leaflet of the plasma membrane. When THP-1 monocytic cells were cultured in the presence of 7beta-hydroxycholesterol (7beta-OH) or 25-hydroxycholesterol (25-OH), prothrombinase, which reflects anionic phospholipid exposure and tissue factor (TF) procoagulant activities, increased in a time- and dose-dependent manner. 7beta-OH appeared 1.5- to 2-fold more potent than 25-OH. Interestingly, no effect of cholesterol itself could be detected on procoagulant activities. Nevertheless, no difference in TF activity could be detected between oxysterol-treated and control cells after disruption. TF antigen expression was the same in oxysterol-treated and control cells as shown by flow cytometry. In contrast, the use of labelled annexin V, a protein probe of anionic phospholipids, revealed an elevated number of cells with exposed phosphatidylserine. Because the latter also constitutes a signal for phagocyte recognition of apoptotic cells and fragments, and a proportion of cells displayed altered morphology with condensed chromatin and membrane blebs, analysis of DNA was performed and indicated apoptosis in oxysterol-treated cells. Hence, oxysterol-induced phosphatidylserine exposure and enhanced TF activity may results from apoptosis. These results suggest relationships between oxysterol and the amplification of coagulation reactions by monocytic cells resulting from induced phosphatidylserine exposure.

Annexin A5↗
PubMed1996

No evidence for mutations in the alpha- and beta-catenin genes in human gastric and breast carcinomas.

Disturbed function of E-cadherin and/or of one of its anchoring proteins, the catenins, is thought to destabilize E-cadherin-mediated cell-cell adhesion, which may enhance the invasiveness of epithelial cells and thus favor carcinoma progression. Reduced expression of E-cadherin and alpha-catenin, as well as mutations in the E-cadherin gene, have been found in various carcinomas, whereas mutations in the alpha- and beta-catenin genes have been described only in carcinoma cell lines. Using reverse transcription-PCR, followed by agarose gel electrophoresis and single-strand conformational polymorphism, we examined 16 diffuse- and 5 intestinal-type gastric carcinomas, as well as 9 lobular and 2 ductal breast carcinomas, for mutations of alpha- and beta-catenin cDNA. All of the investigated tumors were analyzed previously for E-cadherin mutations. Comparing tumorous and nontumorous samples, we detected neither deletions nor aberrant single-strand conformational polymorphism patterns. At nucleotide 2220 of the alpha-catenin gene, we identified one frequent polymorphism. Our findings suggest that, in contrast to E-cadherin, mutations of alpha- and beta-catenin do not contribute to the pathogenesis or the diffuse growth patterns of gastric or breast carcinomas.

Breast Neoplasms↗
PubMed1996

Intraoperative EEG changes in relation to the surgical procedure during isoflurane-nitrous oxide anesthesia: hysterectomy versus mastectomy.

STUDY OBJECTIVES: To investigate topographical changes in electroencephalographic (EEG) frequencies and spectral power density in relation to different surgical procedures (abdominal hysterectomy versus mastectomy) during steady-state isoflurane-nitrous oxide (N2O) anesthesia. DESIGN: Prospective, nonrandomized, open study. SETTING: University hospital. PATIENTS: 34 ASA status I and II patients scheduled for elective abdominal hysterectomy or mastectomy. INTERVENTIONS: 12 patients were studied without surgery (Group I, control). 22 patients were studied for the first 14 minutes following skin incision during hysterectomy (Group 2, n = 11) or mastectomy (Group 3, n = 11). MEASUREMENTS AND MAIN RESULTS: Anesthesia was maintained with 0.6% isoflurane in 66% N2O in oxygen (O2). EEG was recorded via 17 channels followed by calculation of spectral power densities in selected frequency bands for each recording site. In addition, heart rate, mean arterial pressure (MAP), end-tidal carbon dioxide tensions, and isoflurane concentration were recorded. Total observation time was 20 minutes in all groups. At baseline, EEG variables were comparable in all groups. The EEG demonstrated slow wave activity superimposed with alpha waves. Start of surgery resulted in increases of slower waves and decreases in alpha activity. In both surgical groups, these EEG changes were most pronounced at frontal recording sites (p < 0.05) with differences in the frequency content. In Group 2 (hysterectomy), delta-activity became dominant, whereas in Group 3 (mastectomy), a shift to theta waves was observed. During surgery MAP was increased by 40% (Group 2; p < 0.05) and 21% (Group 3; p < 0.05), respectively. CONCLUSIONS: These results show that specific surgical procedures may induce EEG slow wave activity to a different degree. The EEG response varied in relation to the surgical procedure and/or the intensity of noxious stimulation. Mastectomy resulted in the appearance of theta activity whereas, during laparotomy, the EEG frequency content was shifted to delta waves. The topographical analysis indicates spatial inhomogeneities in the EEG responses with a dominance at frontal areas. From this findings, it may be concluded that the electrode montage used for intraoperative EEG recordings has to be carefully selected.

Adult↗
PubMed1996

[Low dosage radiotherapy of subfoveal neovascularizations in age related macular degeneration. Results after 6 weeks and 6 months].

AIM OF THE STUDY: The aim of this pilot study is to test the effect of low dose radiation on classic and occult subfoveal neovascular membranes (SNVM) in age-related macular degeneration. METHODS AND PATIENTS: From November 1993 through to May 1995 the macula of the affected eye was irradiated with 5 Gy for 12 patients and with 8 Gy for 34 patients. The radiotherapy was done ambulatorily by a linear accelerator 6 MeV during 4 consecutive days with daily 1.25 Gy and 2 Gy respectively. A "half beam technic" was used to protect the lens. Before the treatment, 6 weeks and 6 months later different parameters of the visual acuity were measured and a simultaneous Fluo- and ICG-angiography was done. RESULTS: In the 5 Gy group, all the planned controls were done for 11 patients. 9 membranes were classic and 2 occult. After 6 months the vision in the distance remained the same in 7 cases, was better in 2 cases and worse in 2 cases. The size of the membrane increased in 10 cases and remained unchanged in 1 case. In the 8 Gy group, all the planned controls were done for 29 patients. 12 membranes were classic and 17 occult. The vision in the distance remained the same in 17 cases, was better in 4 cases and worse in 8 cases. The size of the membrane increased in 12 cases and there was no change in 17 cases. DISCUSSION AND CONCLUSION: Exact comparisons between the 5 Gy and 8 Gy group are not possible because of the different composition of these groups. In no case were we able to note a reduction of the size of the membrane. Concerning the visual acuity, our results are better than the spontaneous evolutions described in the literature. Meanwhile, affirmations about possible stabilisation of the visual acuity are too early. A further study which is being done in our hospital may possibly bring new information.

Aged↗
PubMed1996

[Observations of choroid pulsation].

BACKGROUND: While performing indocyanine-green (ICG) videoangiograms with the Rodenstock scanning laser ophthalmoscope (SLO), we got more and more aware of visible choroidal pulsation mainly during the inflow of ICG into the eye. We wanted to learn more about the frequency and the different forms of this phenomenon. MATERIAL AND METHODS: We examined 187 consecutive ICG angiographies retrospectively, which were performed with a Rodenstock SLO and stored by videotape. Most patients suffered from age-related macular degeneration and had a mean age of about 70 years. We defined 4 groups of different pulsatile dye inflow in the choroid, namely (group 1) the diffuse form, involving the whole macular region; (group 2) the local form, involving an area smaller than the fovea. In group 3 (mixed form) we found the pulsatile inflow diffuse initially, later on remained a local pulsation. In group 4 (special form) we noticed a localized pulsation of a longer duration (10-15 seconds) and of a special type, namely back and forth movements of dye in one or a few choroidal veins. In addition, we examined the presence of pulsation in the central retinal vein. RESULTS: In 173 of 187 angiograms we could examine the choroidal inflow in the macular region. We found in 94 of these 173 angiograms (or in 54%) choroidal pulsation. 84% of all cases were in group 1, 2 and 3. This probably physiological pulsation occurred mostly in the first few seconds after the inflow of the dye. After about 5 seconds it was normally not visible any more. In our group 4 we collected 16 out of 94 angiograms (or 17%). We could not find a correlation between the presence of a pulsation in the central vein and in the choroid. CONCLUSIONS: Choroidal pulsatile inflow of ICG is a frequent (most probably physiological) phenomenon. The localized pulsation found in several older patients with back and forth movements of dye in one or a few veins may be abnormal; it reflects phasic pressure changes in choroidal veins of low flow. We do not know yet if this phenomenon is of any diagnostic value. However, more studies of these interesting dynamic processes seem to be warranted.

Adult↗
PubMed1996

[Simultaneous digital indocyanine green and fluorescein angiography].

BACKGROUND: The simultaneous recording of indocyanine green and fluorescein angiography is since more than twenty years possible. The real-time digital recording of angiograms is about since 10 years possible. Because of the poor temporal resolution due to technical limitations, both of the above methods were only seldom used routinely. Graphics workstations can digitize and store multiple video sources real-time with full video framerate. Comparing to conventional videoangiography, the quality can be improved significantly. MATERIALS AND METHODS: Simultaneous ICG and Fluorescein (SIF) angiography images of a two-channel Scanning Laser Ophthalmoscope were digitized and stored real-time at a rate of 28-50 images/sec using a graphics workstation. The digitized image sequence could be replayed as a motion picture and/or single images of the recorded sequence could be analyzed separately. RESULTS: The simultaneous digital recording of angiograms is easier, than using two video tape recorders. It was possible to enhance the quality of the stored images using standard digital image processing procedures. Morphological measurements and densitometry were done with software developed for the UNIX workstation, or with personal computers using standard software packages. CONCLUSION: Simultaneous digital ICG and fluorescein angiography has several advantages over conventional video-angiographies: the image quality is better, data retrieval is easier, it is easier to perform than conventional video angiography, image can be accessed through a computer network, it is easy to perform morphological and densitometrical measurements, etc.

Angiography↗
PubMed1996

[Comparison of sevoflurane and isoflurane in ambulatory surgery. Results of a multicenter study].

UNLABELLED: A multicenter, randomized, comparative phase III study evaluating the effect of sevoflurane versus isoflurane in adult outpatients was performed. The aim of the study was to compare (1) maintenance of anaesthesia and (2) how rapidly and easily the patients emerge from the anaesthetic and recover. METHODS: Outpatients were included who underwent scheduled surgical procedures of an anticipated duration of up to 3 h and an anticipated length of hospitalization of less than 24 h post-anaesthesia. Five hundred patients were randomly selected to receive either sevoflurane (n = 247) or isoflurane (n = 253), each administered with oxygen (30-50%) in nitrous oxide. Efficacy was evaluated through the measurement of times of recovery parameters and tests like the objective pain-discomfort scale, the visual analogue scale, and the digit symbol substitution test. Safety was evaluated by monitoring adverse experience, clinical laboratory and non-laboratory testing and physical assessments. RESULTS: No statistical differences were observed between the two treatment groups with respect to demographics and ASA class. All study drug concentrations during each anaesthetic phase were statistically lower in the sevoflurane (average concentration 0.61 MAC) compared to the isoflurane (average concentration 0.70 MAC) group. The mean time to emergence was statistically shorter in the sevoflurane group (8.2 min) than in the isoflurane group (9.3 min). The mean time to response to commands (8.5 min vs 9.8 min) and the mean time to orientation (10.6 min vs 13.0 min) were also statistically shorter in the sevoflurane than in the isoflurane group. The EEG results showed a faster decrease in delta activity and a faster increase in alpha activity in the sevoflurane group than in the isoflurane group, indicating faster awakening. No statistical differences were observed between the two treatment groups for the mean time to any of the remaining post-anaesthesia events. Bradycardia was observed in a statistcally higher percentage of patients in the sevoflurane group (6%) than in the isoflurane group (2%). No other statistical differences were observed between the two treatment groups concerning the incidence of study drug-related adverse experience. The most common adverse experiences were nausea and vomiting. At all post-anaesthesia time points, higher serum inorganic fluoride concentrations were observed in the sevoflurane (maximum 30.2 mumol/l) than in the isoflurane group. No clinical or laboratory renal insufficiency was noted. Eighty-seven percent of patients in the sevoflurane group would request the same anaesthetic technique compared to only 79% of patients in the isoflurane group. CONCLUSIONS: Sevoflurane was as safe as isoflurane for anaesthesia in adult outpatients. Patients who received sevoflurane had statistically significantly shorter recovery parameters than isoflurane patients.

Adolescent↗
PubMed1995

[Clinical aspects of hypophyseal diseases from the viewpoint of the ophthalmologist].

The anatomy of the chiasmal region and the visual symptoms due to pituitary tumors will be presented from the viewpoint of an ophthalmologist. The importance of perimetry in every patient with otherwise unexplained loss of vision is stressed. Other tests (swinging flash light test, colour vision, screening ophthalmoscopy) are mentioned as well. An ophthalmologist should participate in the diagnosis as well as in the follow-up after treatment of any case with pituitary tumors.

Humans↗