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Biomedical subjects

P Carl

Publications and source records attributed to P Carl.

At least 55 records · Page 3Linked to original sources
PubMed1986

Longterm treatment with epidural opioids. A retrospective study comprising 150 patients treated with morphine chloride and buprenorphine.

During a 2-year period, 150 patients were treated with epidural opioids for more than 7 days; 89 received morphine and 61 buprenorphine. In 16 cases, medication was changed from morphine to buprenorphine, and in 6 from buprenorphine to morphine. In 19 patients in each group, the disease process was benign. The median daily dose of morphine was 17 mg given by an average of 2.9 injections; the corresponding figures in the buprenorphine group were 1.3 mg and 2.6 injections. The mean duration of treatment was 49 days (7-397) in the morphine group and 53 days (7-262) in the buprenorphine group. Satisfactory pain relief was achieved in 40 (45%) patients who received morphine and 41 (67%) patients given buprenorphine. Altering medication from morphine to buprenorphine improved analgesia in 32% of patients, while the reverse improved pain relief in a further 46% of the patients. Side effects were reported in 46% of patients given morphine and 20% given buprenorphine. Seventy-one patients were treated on an outpatient basis. In these cases, buprenorphine was administered for 89% of the total duration of treatment and morphine chloride for 52%.

Buprenorphine↗
PubMed1986

Epidural buprenorphine for postoperative analgesia. A controlled comparison with epidural morphine.

In a double-blind controlled study, epidural buprenorphine 0.3 mg was compared with 4 mg of epidural morphine for postoperative pain relief the first 24 hours after major orthopaedic surgery. The degree of analgesia was equal and satisfactory in both groups. Duration of action was 620 minutes with buprenorphine and 580 minutes with morphine, which was not significantly different. The only serious side effects were recorded in the morphine group, with two patients complaining of pruritus and five of urinary retention. In conclusion, epidural buprenorphine did not offer any advantages in preference to morphine for postoperative pain relief following orthopaedic surgery.

Adolescent↗
PubMed1986

Ro 15-1788 for postoperative recovery. A randomised clinical trial in patients undergoing minor surgical procedures under midazolam anaesthesia.

In a double-blind randomised study, 100 women who underwent induced abortion under midazolam anaesthesia were given the benzodiazepine antagonist Ro 15-1788 or placebo after termination of anaesthesia. Recovery was assessed by means of a modified Steward coma scale. Following incremental doses of Ro 15-1788, 56% of the patients were fully awake within 3 minutes and 92% after 5 minutes, which was significant compared to the placebo group. The median duration of amnesia was 91 minutes after Ro 15-1788 compared to 121 minutes in the placebo group (p less than 0.001). The median dose of Ro 15-1788 was 0.4 mg. A slight positive correlation between total dose of Ro 15-1788 and total amount of midazolam was found. Nausea and/or vomiting were found to be more frequent in the Ro 15-1788 group, but otherwise we found no differences between groups with regard to either side effects or cardiorespiratory function. Ro 15-1788 is evidently an effective antagonist to the sedation induced by midazolam.

Abortion, Induced↗
PubMed1986

Potentiation of epidural opioids with epidural droperidol. A one year retrospective study.

During a period of one year, 119 patients with chronic pain received injections of opioids via a catheter inserted in the lumbar epidural space. Twenty-three patients (19%) showed evidence of tolerance and were given droperidol 1.25-5.0 mg epidurally. In 20 patients in this study, there was a significant reduction in the number of epidural opioid injections. Six patients complained of excessive sedation, which disappeared when the dose of droperidol was reduced, although this did not affect the analgesia. One patient given an accidental overdose of droperidol developed reversible Parkinsonism. It is concluded that epidural administration of the dopamine antagonist droperidol may be beneficial as supplementary medication to epidural opioids when tolerance develops.

Adult↗
PubMed1986

[Cancer of the urachus].

Carcinoma of urachal origin is a special type of primary vesical adenocarcinoma. Because of the anatomic and histologic character of this tumour the therapy is different from that of transitional carcinomas. Diagnostic modalities including ultrasonography and computed tomography are demonstrated. The findings are compared with those of an ovarial carcinoma metastasis also located in the bladder dome.

Adenocarcinoma↗
PubMed1986

[Cancer induction by urinary drainage or diversion through intestinal segments?].

Since the introduction of ureterosigmoidostomy 79 cases of adenocarcinomas of the sigmoid near the implantation site of the ureters were described. Clinical and experimental data indicate that the excretion of urine and faeces together leads to endogenous nitrosamine synthesis and thus induces carcinomas. Other factors--like carcinogens excreted with the urine or chronic irritation of the mucosa by urine--could also cause carcinomas in the urine diverting parts of the intestine. Based on our own cases and a study of the literature we investigated whether other forms of urinary diversion can induce tumors. So far 4 tumor cases in ileum conduits and 2 cases in colon conduits have been reported together with 2 tumors in bladder augmentation (ileocystoplasty). We found in our material 1 case of cancer in a rectum bladder, 1 in a colocystoplasty, and 2 after ureterosigmoidostomy. In ureter substitution plasty and following Kock- or Camey-technique no cases of tumor induction have been reported so far. From the presently available data it must be concluded that urinary diversion using intestine may cause tumor induction. With the interval between surgery and evidence of tumor being at least 20 years a sharp increase in morbidity must be expected for the years after 1990. This leads to the demand that all patients with urinary diversion using intestine must be regularly evaluated by radiological, endoscopic and bioptic controls. These oncological aspects should be considered for the appropriate choice of urinary diversion especially in children.

Humans↗
PubMed1985

Analysis of proliferative compartments in human tumors. II. Seminoma.

Growth pattern and cell kinetics of 12 human seminomas were determined by means of vascular organ perfusion after orchiectomy. The arteria testicularis of the tumor-bearing testis was perfused up to 5 hours with dextran-diluted blood under normothermic and normotonic, simulated physiologic conditions. At defined periods, the specimen was exposed to tritiated and/or carbon 14-labeled thymidine. Autoradiograms prepared of whole tumor sections revealed a dependence of growth pattern on the stage of development. A homogeneous distribution of DNA synthesizing seminoma cells was found in small tumor foci. With increasing size, the zone of proliferation shifted to the periphery of the nodule giving rise to nodular subpopulations of high proliferative activity. In nodules of a diameter of more than about 2 cm the growth compartment consists of a highly proliferating invading cell layer at the edge of the tumor and intratumoral patches of proliferating cells near the vascular stroma. The largest part of the tumor remains at this stage in a quiescent state (G0). The mean labeling index of the seminoma cells was 11.6 +/- 1.4%, with the highest values found immediately adjacent to tumor vessels. High mitotic activity in an anaplastic seminoma was coupled with maximum labeling indices up to 41.9%. DNA synthesis time ts was 15.9 +/- 2.0 hours. The potential population doubling time for the proliferating fraction was in the range of 5 days. Lymphocytic infiltration reduced the proliferative activity in some parts, but was without effect in other areas of the seminoma. The seminoma is an example of a malignant human tumor with a rather regular growth pattern: The distribution of the proliferating compartment appears less dependent on cytologic or histologic structure, but more on tumor geometry and size.

Adult↗