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Biomedical subjects

P Carl

Publications and source records attributed to P Carl.

At least 37 records · Page 2Linked to original sources

Ileal bladder augmentation combined with ileal ureter replacement in advanced urogenital tuberculosis.

We report a case of active tuberculosis associated with a right nonfunctioning kidney and nearly total loss of bladder capacity. Percutaneous nephrostomy and right nephroureterectomy were performed while the patient was undergoing triple drug therapy. Definitive surgical treatment consisted of ileal bladder augmentation and ileal ureter replacement. Normal urodynamics of the upper urinary tract and normal voiding with complete return of bladder capacity were achieved. Metabolic acidosis was treated successfully by sodium hydrogen carbonate.

Aged↗

Effects of eltanolone on cerebral blood flow and metabolism in healthy volunteers.

BACKGROUND: Eltanolone is a new steroid anesthetic agent that may prove to be useful in clinical practice. The aim of the present study was to evaluate the effects of eltanolone on cerebral blood flow (CBF) and metabolism in healthy volunteers. METHODS: In a randomized cross-over study, eight subjects received intravenous eltanolone 0.6 mg/kg or its vehicle. CBF was measured with the intravenous xenon 133 technique before and 2 and 30 min after administration of eltanolone or vehicle. Cerebral metabolic rate for oxygen (CMRO2) was calculated as the product of the measured cerebral arteriovenous oxygen content difference and the blood flow. RESULTS: CBF decreased from a baseline value of 64 +/- 4 (mean +/- SD) to 42 +/- 6 ml.100 g-1.min-1 at 2 min after administration of eltanolone and only 4% after vehicle. Cerebral oxygen consumption was 4.1 +/- 0.4 ml.100 g-1.min-1 at baseline and decreased to 2.7 +/- 0.6 at 2 min after eltanolone, whereas metabolism did not change significantly after administration of vehicle. At 30 min CBF and Cerebral metabolic rate for oxygen were 16 and 10% less than baseline values, respectively. Coupling between CBF and Cerebral metabolic rate for oxygen was preserved at all measurements. After administration of eltanolone a significant decrease in mean arterial blood pressure of 6 mmHg and a period of hypoventilation were observed. This did not occur after injection of vehicle. CONCLUSIONS: Eltanolone was shown to reduce cerebral oxygen consumption and blood flow in healthy volunteers. Coupling between metabolism and flow was preserved.

Adult↗

Pharmacokinetics and pharmacodynamics of eltanolone (pregnanolone), a new steroid intravenous anaesthetic, in humans.

Eltanolone, a new intravenous steroid anaesthetic agent was administered intravenously in a dose of 0.6 mg.kg-1 over 45 s to eight healthy male volunteers to evaluate some of its pharmacokinetic and pharmacodynamic effects. Drug concentration-time data were analysed by PCNONLIN, a non-linear regression programme, showing data consistent with a three-compartment model with initial distribution half-life t1/2 lambda 1 between 0.3 and 2 min, intermediate distribution half-life t1/2 lambda 2 between 12 and 29 min and terminal half-life t1/2 lambda z between 72 and 212 min. The total body clearance of eltanolone was rapid and with individual values in the range 1.6-2.3 l.h-1.kg-1. Eltanolone was initially distributed into a relatively large central compartment V1 between 0.09 and 0.98 l.kg-1 and then extensively further distributed (Vss between 1.80 and 5.44 l.kg-1 and V between 4.87 and 11.87 l.kg-1). The excretion of unchanged of eltanolone in urine was very small, the renal clearance was less than 0.5% of the total clearance. Induction of anaesthesia was trouble free with onset and duration of anaesthesia between 1-2 min and 6-13 min, respectively. There was slight respiratory depression, a small transient increase in heart rate, and a maximum reduction in arterial blood pressure of 23%, as compared with the resting level. Pain on injection and venous sequelae were not seen. Involuntary movements were seen in one subject. We conclude that eltanolone has a favourable pharmacokinetic profile with relatively rapid half-lives, large distribution volumes and rapid total body clearance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Cytogenetic survey of 32 cancers of the prostate.

Cytogenetic studies after short-term culture were performed on 32 adenocarcinomas of the prostate from patients without prior treatment. The tumor specimens, ranging from stage B1 to D1, were obtained by radical prostatectomy or diagnostic biopsies. Fourteen tumors showed a normal diploid chromosome complement in all metaphases examined. Clonal chromosomal alterations were detected in 16 tumor samples and the remaining two cases contained double minute (dmin) chromosomes in some cells. The most frequent numerical changes included loss the Y chromosome and trisomy 7, both found in four cases. The only recurrent structural aberration was del(10)(q24), seen in three cases both as a sole anomaly and within multiple rearrangements. Six patients showed cytogenetically unrelated clones. The occurrence of the chromosomal changes found in this study shows no relationship to certain histopathologic characteristics of the tumors. The recurrent finding of del(10)(q24) as sole anomaly and the evidence for clonal evolution in one patient demonstrates that this change is an early karyotypic event which may be important for the pathogenesis in at least a subset of prostatic cancers.

Chromosome Aberrations↗

Venous pressure in idiopathic varicocele.

In 27 patients with clinically identified idiopathic left varicocele, a retrograde venography and a combined pressure measurement in the vena cava, vena renalis and vena spermatica was performed. During Valsalva maneuver the pressure values increased. We could not confirm increased pressure values in the left renal vein dependent on the patient's position. There were no increasing pressure gradients between vena renalis and vena cava in erect position. Therefore an elevated pressure in the left renal vein and especially the 'upper nutcracker' does seem to be of at least limited importance for the pathogenesis of idiopathic varicocele.

Adolescent↗

The effect of the benzodiazepine antagonist, flumazenil, on psychometric performance in acute ethanol intoxication in man.

The effect on cognitive and psychomotor performance of the benzodiazepine (BZD) antagonist, flumazenil, in antagonising the central effect, of ethanol in man has been investigated. Eight healthy adult male volunteers, aged 23 to 32 years, participated in the study. Following a loading infusion, stable blood ethanol levels with a mean value of 1.6 g x l-1 were produced by a maintenance infusion. When stable blood levels of ethanol were reached, 5.0 mg flumazenil/placebo was administered intravenously, and after 15 and 75 min a test battery evaluating psychomotor and cognitive functions was applied. The test battery was sensitive to the test model, but no significant improvement in the test scores could be demonstrated following the administration of flumazenil. It is concluded that flumazenil has no influence on psychomotor functions in acute ethanol intoxication.

Adult↗

Vesico-ovarian fistula in suppurative ovarian inflammation and salpingitis.

The development of fistulas between the bladder and right ovary in a 27-year-old woman is reported. This exceedingly rare form of an internal vesical fistula occurred as a consequence of dextrolateral adnexitis with suppurative ovarian inflammation after placement of an intrauterine pessary. Therapy consisted of removal of the right adnexa, excision of the fistulous duct and suturing of the bladder.

Adult↗

Pregnanolone emulsion. A preliminary pharmacokinetic and pharmacodynamic study of a new intravenous anaesthetic agent.

Pregnanolone emulsion, a new steroid anaesthetic agent, was administered intravenously as bolus doses to six young healthy male volunteers in a preliminary pharmacokinetic and pharmacodynamic study. The plasma concentration-time curves fitted a two-compartment model. The elimination half-life was between 0.9 and 1.4 hours, volume of central compartment between 0.95 and 2.10 litres/kg, volume of distribution between 3.75 and 5.58 litres/kg and total body clearance between 1.80 and 3.07 (litres/hour)/kg. The excretion in urine of unchanged pregnanolone was less than 0.1%. The pharmacodynamic properties were found to be similar to those of Althesin, with immediate induction of anaesthesia of short duration. The anaesthetic affected haemodynamics only slightly; minor depression of ventilation, with an increase in PaCO2, occurred in several of the subjects. Excitation of short duration occurred in one subject during induction of sleep and slight involuntary muscle movements in another subject during sleep. It is impossible to draw any clear conclusions of the clinical efficacy and tolerance from this limited normal subject trial, but pregnanolone emulsion seems worthy of further clinical trial.

Anesthesia Recovery Period↗

Identification and catabolic activity of well-derived gasoline-degrading bacteria from a contaminated aquifer.

Approximately 300 gasoline-degrading bacteria were isolated from well water and core material from a shallow coastal aquifer contaminated with unleaded gasoline. Identification of 244 isolates revealed four genera: Pseudomonas, Alcaligenes, Nocardia, and Micrococcus, with pseudomonads making up 86.9% of bacteria identified. A total of 297 isolates was sorted into 111 catabolic groups on the basis of aerobic growth responses on 15 gasoline hydrocarbons. Each test hydrocarbon was degraded by at least one isolate. Toluene, p-xylene, ethylbenzene, and 1,2,4-trimethylbenzene were most frequently utilized as growth substrates, whereas cyclic and branched alkanes were least utilized. Most isolates were able to grow on 2 or 3 different hydrocarbons, and nearly 75% utilized toluene as a sole source of carbon and energy. Isolates were remarkably specific for hydrocarbon usage, often catabolizing only one of several closely related compounds. A subset of 220 isolates was sorted into 51 groups by polyacrylamide gel electrophoresis. Pseudomonas aeruginosa was partitioned into 16 protein-banding groups (i.e., subspecies) whose catabolic activities were largely restricted to substituted aromatics. Different members of subspecies groups defined by protein-banding pattern analysis often exhibited different growth responses on the same hydrocarbon, implying marked strain diversity. The catabolic activities of well-derived, gasoline-degrading bacteria associated with this contaminated aquifer are consonant with in situ adaptation at the site.

Bacteria, Aerobic↗

A randomized comparison between midazolam and thiopental for elective cesarean section anesthesia. I. Mothers.

In a randomized blind trial midazolam (0.3 mg kg-1) was compared with thiopental (4 mg kg-1), both combined with meperidine-nitrous oxide, for elective cesarean section anesthesia in 40 women. We found no statistically significant differences between thiopental and midazolam at induction, during operation or recovery with regard to maintenance doses, change in maternal neurologic status based on a modified Glasgow Coma Scale, systolic blood pressure, and heart rate. Induction time was 120 seconds with midazolam and 111 seconds with thiopental. There were significant differences with regard to diastolic blood pressure. Side effects occurred with approximately equal frequencies, but vomiting was significantly more frequent after thiopental. Perivenous tenderness and erythema occurred in four patients, all after thiopental. Midazolam appears to be a suitable alternative to thiopental for the induction and maintenance of anesthesia for elective cesarean section.

Adolescent↗

A randomized comparison between midazolam and thiopental for elective cesarean section anesthesia: II. Neonates.

In a randomized blind trial, the general condition of 40 neonates was assessed following midazolam- or thiopental-based general anesthesia for elective cesarean section. Among 19 neonatal neurobehavioral observations and tests, statistically significant differences between the midazolam and the thiopental groups were rare. However, a statistically significant interaction with regard to body temperature, general body tone, and arm recoil was observed where results were inferior for midazolam, although only within the first 2 hours. It was concluded that midazolam is as safe as thiopental for the induction and maintenance of elective cesarean section anesthesia in neonates.

Anesthesia, Obstetrical↗

A randomized comparison between midazolam and thiopental for elective cesarean section anesthesia: III. Placental transfer and elimination in neonates.

Forty neonates delivered by cesarean section were studied, half being delivered of mothers in whom anesthesia was induced with midazolam (0.3 mg/kg intravenously) and half of mothers given thiopental (4 mg/kg). At delivery, blood samples from mother and the umbilical vein were drawn for determination of plasma concentrations of thiopental, midazolam, and alpha-hydroxymidazolam. Over the next 60 hours, three blood samples were drawn using a randomized procedure of two blood samples at 30 different times. Placental transfer, expressed as the umbilical/maternal concentration ratio, was 0.96, 0.66, and 0.28, respectively, for thiopental, midazolam, and alpha-hydroxymidazolam. The transfer of thiopental was significantly more rapid than the transfer of midazolam and alpha-hydroxymidazolam. The population average of elimination half-life in neonates was 6.3 hours for midazolam and 14.7 hours for thiopental. Both values are substantially larger than those found in previous studies in adults.

Anesthesia, Obstetrical↗

Anticonvulsive properties of pregnanolone emulsion compared with althesin and thiopentone in mice.

The anticonvulsive properties of pregnanolone (as an emulsion) were evaluated in mice and compared with similar properties of Althesin and thiopentone. Pregnanolone emulsion was found to antagonize convulsions induced by the GABA antagonists pentetrazole, bicuculline and picrotoxin and by the specific glycine receptor antagonist, strychnine. The drug was effective in all four convulsive tests at subanaesthetic doses with maximal activity appearing within less than 1 min. The anticonvulsive therapeutic indices of pregnanolone emulsion were superior when compared with the therapeutic indices of Althesin and thiopentone in all four tests. Pregnanolone emulsion might be a useful alternative drug in the management of convulsive states resistant to conventional therapy.

Alfaxalone Alfadolone Mixture↗

Pregnanolone emulsion. A new steroid preparation for intravenous anaesthesia: an experimental study in mice.

The anaesthetic activity of pregnanolone (a metabolite of progesterone) in emulsion formulation administered intravenously to male mice was compared with that of Althesin. The loss of righting reflex for 15 seconds was used to estimate the anaesthetic effect. The mean anaesthetic dose (AD50) for the pregnanolone emulsion was 5.25 mg/kg and for Althesin, 2.8 mg/kg. The mean lethal dose (LD50) was 44 mg/kg for pregnanolone and 54 mg/kg for Althesin. The sleeping time after pregnanolone was 2.5-3.5 times longer than after Althesin in dosages above 7.5 mg/kg. No signs of pain or local reaction from injection were observed for either of the drugs. The onset of action was fast for both drugs, with only minor signs of excitation, and recovery was rapid and without excitation. The results indicate that the anaesthetic properties of pregnanolone emulsion are very similar to those of Althesin. Further studies will show whether it can fill the major vacuum left in anaesthetic practice after the withdrawal of Althesin.

Alfaxalone Alfadolone Mixture↗

Anaesthetic properties of pregnanolone emulsion. A comparison with alphaxolone/alphadolone, propofol, thiopentone and midazolam in a rat model.

The anaesthetic properties of pregnanolone emulsion, a new steroid preparation for intravenous administration, were evaluated in rats and compared to those of Althesin, propofol, thiopentone and midazolam. The therapeutic index was found to be 50% higher than that of Althesin and 6-8 times higher than those of propofol, thiopentone and midazolam. Induction with pregnanolone emulsion was reliable and fast, with only minor excitatory side effects, although induction time was longer compared to Althesin, propofol and thiopentone. Movement of unstimulated rats during sleep was similar to that seen with Althesin but movement on painful stimulation was less than with propofol and thiopentone. Recovery was rapid and smooth, and the proportion of sleeping time to recovery time was higher than found for the other four anaesthetics. No cumulative effects were seen on repeated administration and there were no venous sequelae. The results indicate that pregnanolone emulsion may provide a short-acting, less cumulative and less toxic alternative to existing intravenous anaesthetic agents.

Alfaxalone Alfadolone Mixture↗

The anticonvulsive activity and toxicity of diazepam in three different formulations. An experimental study in mice.

The anticonvulsive activity (ED50), acute toxicity (LD50), and minimal neurotoxicity (TD50) of diazepam in an emulsion form (Diazemuls) were compared with two different water-based diazepam solutions (Valium and Stesolid). The diazepam preparations were administered intravenously to male mice. After determination of time of peak drug activity, the ED50's were established against pentetrazol-induced convulsions, at peak drug activity. The most important difference between the three diazepam preparations was a significantly higher LD50 of diazemuls (275 mg/kg) compared to valium (49 mg/kg) and stesolid (51 mg/kg). ED50 was: diazemuls 0.24 mg/kg, valium 0.14 mg/kg and stesolid 0.10 mg/kg. The therapeutic indices (LD50/ED50) were thus calculated to be 1146 for diazemuls, 350 for valium and 510 for stesolid. Time of peak drug activity and TD50 were equal for all three drugs. No signs of pain on injection or necrosis were observed following diazemuls, whereas this was common after valium and stesolid.

Animals↗

Pain relief after major abdominal surgery: a double-blind controlled comparison of sublingual buprenorphine, intramuscular buprenorphine, and intramuscular meperidine.

In a double-blind randomized study of three groups of 18 patients scheduled for major abdominal surgery the efficacy and side effects of sublingual buprenorphine were tested and compared to intramuscular meperidine and buprenorphine. Single doses of either 75 mg of meperidine, 0.4 mg of sublingual buprenorphine, or 0.3 mg of intramuscular buprenorphine were used. Patients given buprenorphine as sublingual tablets were significantly more conscious in the immediate postoperative period (Glasgow Coma Scale) than when given buprenorphine or meperidine intramuscularly. Median pain intensity differences (PID) showed equal pain relief, whereas the summarized pain intensity differences (SPID) were significantly higher in the intramuscular buprenorphine group compared to the meperidine group. Three cases of respiratory acidosis in the meperidine group required IPPV treatment, and one case in the intramuscular buprenorphine group required treatment. Sedation and nausea were the most common side effects in all three groups. We conclude that sublingual buprenorphine is useful for relief of postoperative pain and exhibited administrative advantages, when the patients were able to cooperate.

Abdomen↗