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Biomedical subjects

P Neumann

Publications and source records attributed to P Neumann.

At least 91 records · Page 5Linked to original sources
PubMed1985

A controlled study on the effect of epidural analgesia with local anaesthetics and morphine on morbidity after abdominal surgery.

A hundred patients scheduled for elective abdominal surgery were randomized to either general anaesthesia (low-dose fentanyl) and systemic morphine for postoperative pain or combined general anaesthesia and epidural analgesia with etidocaine 1.5% intraoperatively (T4-S5) and bupivacaine 0.5% 5 ml/4 h for 24 h and morphine 4 mg/12 h for 72 h. Postoperative pain was better controlled by the epidural regimen (P less than 0.0001). We found no significant reduction in postoperative mortality (6% to 2%), pneumonia (28% to 20%), cardiac dysrhythmia (10% to 5%) and wound complications (14% to 11%) by the epidural analgesic regimen. The incidence of deep venous thrombosis (125I-fibrinogen scan) was 32% after general anaesthesia and low-dose heparin and 34% after epidural analgesia with no prophylactic antithrombotic treatment (P greater than 0.9). Postoperative weight loss and decrease in serum-albumin and serum-transferrin, as well as the reduction in haemoglobin and the need for postoperative transfusions, were similar in the two groups. Convalescence, as assessed by postoperative fatigue, restoration of bowel function (flatus, bowel movement and food intake) and the time until the patients were self-aided at their preoperative level, was not reduced by epidural analgesia. Since 50% of the patients in each group suffered from one or more of the above-mentioned postoperative complications, this epidural regimen was not effective in reducing postoperative morbidity after major abdominal surgery despite the achievement of adequate pain relief.

Abdomen↗
PubMed1985

[Alcohol consumption and chronic gastritis].

History of alcohol intake was evaluated in 1,500 patients who had gastroscopy for different reasons. Alcohol intake was related to histological findings of antrum and corpus mucosa. No statistically significant correlation between lesions and alcohol intake could be found. There was a correlation between incidence and severity of gastritis on the one hand and increasing age on the other. The patients under investigation were beer drinkers in the first line. For this reason our findings do not allow any conclusions in regard to persons, who usually drink higher concentrated alcohol beverages. The conclusion can be drawn however that even excessive drinking of beer does not seem to cause chronic gastritis.

Adolescent↗
PubMed1985

[Follow-up of patients with anterior wall aneurysms using radionuclide ventriculography].

32 patients with a large anterolateral aneurysm were studied by using biplane ventricular angiography and rest and exercise radionuclide ventriculography (gated-blood-pool method). The correlation coefficient of biplane ejection fraction by angiography and radionuclide ventriculography was poor (r = 0.65), but repeated investigations and interobserver comparison showed nearly identical values, therefore we used the gated-blood-pool method (GBP) for follow-up investigations in patients with an aneurysm of the anterolateral wall. 11 patients were studied before and 17 +/- 6 months after left ventricular aneurysmectomy. Resting ejection fraction (LVEF) increased significantly from 28 +/- 8 to 38 +/- 8% (p less than 0.005), but exercise LVEF did not. In 21 patients with medical therapy the second GBP measurement after 16 +/- 6 months showed so significant changes in biplane LVEF (33 +/- 9 and 31 +/- 7%, respectively). During exercise LVEF remained unchanged after aneurysmectomy but increased slightly by 5% (p less than 0.05) in the medically treated group. The regional wall motion was unchanged in patients with medical therapy, but after aneurysmectomy there was a significant increase in local ejection fractions in the anterolateral, apical and posterolateral region. The gated-blood-pool methods is suitable for the determination of left ventricular function in patients with anterolateral aneurysm and may be used for follow-up studies. Left ventricular aneurysmectomy is effective in improving resting ventricular function, whereas in patients with medical therapy LV function remains unchanged.

Cardiac Output↗
PubMed1984

Analysis of left ventricular regional motility: a comparison of different methods.

Multiple gated blood pool (MUGA) and contrast ventriculographic studies were performed within 24 h in 80 patients, 20 with 120 normokinetic wall segments and 60 with wall motion abnormalities in 239 of 360 wall segments. Three methods of evaluation of the radionuclide ventriculograms were compared with the results of the biplane contrast ventriculography which served as a standard: (1) qualitative analysis of the cine mode, (2) analysis of parametric scans (amplitude and phase images) and the phase histogram obtained by Fourier analysis, (3) quantitative determination of regional ejection fraction. Normal values were obtained from 20 patients with normal wall motion in the contrast angiogram. The overall sensitivity for the detection of wall motion abnormalities of high degree was 96% for method 1, 95% for method 2, and 90% for method 3, for those of low degree 72% for method 1, 63% for method 2, and 75% for method 3. Combining methods 2 and 3 the sensitivity was increased to 99% for high grade and to 81% for low grade wall motion abnormalities. The two methods showed a complementary effect because of different sensitivities in dependence of the localization of the wall motion abnormality. Although a high efficiency for the evaluation of left ventricular function was provided by the qualitative analysis of the cine mode the combination of Fourier analysis and the determination of regional ejection fraction should be preferred. It increases the sensitivity for the detection of wall motion abnormalities. Moreover, it offers quantitative data which improve the reproducibility and decrease the observer variability.

Angiography↗
PubMed1984

Failure of epidural analgesia to modify postoperative depression of delayed hypersensitivity.

Delayed hypersensitivity to four common antigens was assessed in 32 patients undergoing major abdominal surgery randomly allocated to either general anesthesia (fentanyl + O2/N2O + postoperative pain relief with systemic opiates) or general anaesthesia + epidural analgesia (local anaesthetics + morphine) continued for 72 h. Skin-test responses were performed 2 days before surgery and 1 day after surgery and compared to a similar retesting schedule in 16 comparable non-operative control patients. Cumulated mean skin-test responses increased from 1290 to 2330 mm2 (P less than 0.0001) during retesting in the non-operative control group. In contrast, mean skin-test responses in patients operated during general anaesthesia + systemic opiates for postoperative pain relief fell from 1422 to 1227 mm2 (P = 0.3) and in patients receiving epidural analgesia from 1228 to 890 mm2 (P = 0.06), without statistically significant differences between these two groups (P greater than 0.5). Thus, surgery leads to depression of delayed hypersensitivity and this impairment in immunofunction is not modified by an epidural analgesic regimen providing adequate pain relief.

Aged↗
PubMed1983

[Comparison of various tuberculin tests].

In 188 children results of the Mendel-Mantoux (10 or 100 IU) tuberculin test given intracutaneously were compared with ointment and patch tests as well as with three multipuncture tests using dried or fluid old or purified tuberculin. The new and easily performed multipuncture test with liquid old-tuberculin was significantly superior at 89.4% positive reactions to the other tests (Mendel-Mantoux test as standard at 100%). There were no false-positive results.

BCG Vaccine↗
PubMed1983

Mutagenicity evaluation of amino-oxazoline derivatives using in vitro and in vivo short-term tests.

During routine investigation of potential drugs it was found that 1-methyl-4-(2-oxazoline-2-ylamino)-indazole (1) compound 1 was mutagenic for Salmonella typhimurium TA1535 and TA100. The genotoxicity of compound 1 was confirmed by the following in vitro test systems: V79 Chinese hamster cells (HGPRT-locus), Saccharomyces cerevisiae D7 (mitotic gene conversion, mutations, aberrations), and Escherichia coli (rec-assay). On the other hand, when compound 1 was tested in vivo (micronucleus test in mice and sister chromatid exchange in Chinese hamsters) it did not show evidence of genotoxic activity. In order to study structure/activity relationships, different analogues of compound 1 were tested in Salmonella typhimurium TA1535. The tests showed that (1) most 2-amino-oxazolines were mutagenic for the test organism; (2) the 2-amino-imidazoline and 2-amino-thiazolidine derivatives tested were not mutagenic; (3) substituents bound to the extranuclear nitrogen of the 2-aminooxazoline ring had only a weak influence on the mutagenic potential; and (4) methylation of the oxazoline ring, most conspicuously at the carbon in position 5, strongly reduced the mutagenic effect. From these observations it is concluded that the reaction of nucleophilic DNA sites with the most electrophilic site of the oxazoline ring, ie, the carbon in position 5, is responsible for the genotoxicity of amino-oxazoline compounds. Due to the genotoxicity observed in these in vitro tests this class of compounds was no longer developed, but dropped, even without performing a long-term carcinogenicity study or considering the negative in vivo findings.

DNA Repair↗
PubMed1983

Visualizing cardiac blood pool: comparison of three labeling methods.

The quality of three different labeling methods of visualizing the cardiac blood pool was investigated in 72 patients: 99mtechnetium labeling of red blood cells in vivo or in vitro and human serum albumin. By the simplified technique of in vitro labeling of RBC from the view point of (1) labeling efficiency, (2) activity in the blood, (3) count rates in a standard ROI over the left ventricle and the paracardiac background, (4) ratio of these count rates, and (5) evaluation of image quality, the best results were obtained. HSA and in vivo labeled RBC led to satisfactory results for visual assessment of ventricular performance in most cases. In spite of the slightly higher technical investment involved in the in vitro labeling method this technique appears to be preferable for gated cardiac blood pool studies in view of the excellent labeling quality.

Coronary Circulation↗
PubMed1983

Branchial ion exchange and acid-base regulation after strenuous exercise in rainbow trout (Salmo gairdneri).

Specimens of rainbow trout (Salmo gairdneri) were electrically stimulated to exhausting activity in a closed water recirculation system and the changes in dorsal aortic plasma pH, PCO2, PO2, O2 content, [Na+], [Cl-], [K+], [Lactate-] and Ht were measured during a 24 h recovery period. Net transfer of H+, Na+, Cl- and ammonia between fish and environment were determined by measurement of the concentration changes in the recirculating water. Strenuous exercise resulted in a severe lactacidosis which was corrected by transient net transfer of H+ ions to the environmental water within 4 h, about 6-8 h before the lactate was metabolically removed. The net transfer of H+ ions was achieved in part by branchial HCO3-/Cl- ion exchanges, but to a larger extent by branchial exchange of H+ and/or NH4+ against Na+. The excretion of ammonia, which was considerably enhanced during the first 4 h after exercise, was at least partially due to non-ionic diffusion across the gill epithelium. The observed elevation in ammonia excretion was probably the result of an exercise-induced increase in nitrogen metabolism rather than of production of ammonia for the purpose of acid-base regulation.

Acid-Base Equilibrium↗
PubMed1983

In vitro effects of calcium antagonists PN 200-110, nifedipine, and nimodipine on human and canine cerebral arteries.

PN 200-110 [4-(2,1,3-benzoxadiazol-4-)-1,4-dihydro-2,6-dimethyl-pyridine-3,5-dicarboxylic acid methyl 1-methylethyl ester], a new dihydropyridine derivative, was investigated by recording isometric tension on spiral strips from human and canine arteries in tissue baths at 37 degrees C. Responses to increasing concentrations of CaCl2 were investigated in calcium-free depolarizing solution (60 mmol/L KCl in equimolar replacement for NaCl, 50 mmol/L TRIZMA buffer, pH 7.4). Comparison of those concentrations that reduced the vasoconstrictor response to 1.6 mmol/L CaCl2 by 50% revealed the following order of potencies on both human and canine arteries: PN 200-110 greater than nimodipine greater than nifedipine. Responses to 5-hydroxytryptamine (5-HT) and blood were investigated in Krebs-Henseleit solution (NaHCO3 buffer). On canine arteries, PN 200-110 antagonized responses to 5-HT when used at 10-30 pmol/L; it was approximately 70 times more potent on basilar than on mesenteric arteries, whereas both nifedipine and nimodipine were, respectively, approximately 10 and 6 times more potent on basilar than on mesenteric arteries. When canine basilar arteries were constricted by the addition of blood to the organ bath, each of the investigated dihydropyridine derivatives elicited concentration-dependent relaxation, producing the following order of potencies: PN 200-110 greater than nifedipine = nimodipine. On human anterior cerebral arteries, the blood-induced contractions were counteracted in the following rank order: PN 200-110 = nimodipine greater than nifedipine. The results suggest that due to its potent calcium-blocking activity on cerebral arteries, PN 200-110 might be of value for the prevention and treatment of cerebrovascular spasms following subarachnoid hemorrhage.

Animals↗
PubMed1983

The mechanism of intracardiac shunting in the lizard Varanus exanthematicus.

Intracardiac shunting was studied in unanaesthetized and unrestrained specimens of Varanus exanthematicus by simultaneous injection of radioactively labelled microspheres (15 micron) into the right and left atria. Lung ventilation was monitored by intratracheal pneumotachography. It was found that intracardiac shunting was not significantly affected by the spontaneously occurring periods of ventilation and apnoea: the right-to-left shunt averaged 29 and 31%, respectively, and the left-to-right shunt was 11% in both conditions. The observed shunting, although rather constant with time and independent of the ventilatory state, varied in different individuals. Anatomical studies and intracardiac pressure measurements revealed that, in spite of crocodilian-like systolic pressure separation between pulmonary and systemic circulation (based on the muscular ridge, 'Muskelleiste', between cavum venosum and cavum pulmonale), the cavum venosum is shared by both the pulmonary and the systemic circulation. Intracardiac shunting appears to be mainly due to wash-out of the cavum venosum: blood remaining in this chamber at the end of systole (oxygenated) or at the end of diastole (deoxygenated) is washed into the respective 'inadequate' vascular bed during the next half-cycle of heart action. Thus the extent of intracardiac shunting is expected to depend primarily on the volume and the changes in volume of the cavum venosum during the cardiac cycle.

Animals↗
PubMed1983

Nitrates in aortic valve disease: acute and chronic effects.

The beneficial effect of Nitroglycerin (NTG) on myocardial oxygen-supply-demand ratio in severe aortic stenosis has been already demonstrated. But the chronic administration of isosorbide dinitrate (ISDN) does not reduce the increase in left ventricular filling pressures during exercise. Therefore in severe aortic stenosis, the effects of chronic nitrate administration on left ventricular hemodynamics during exercise do not correspond to the beneficial acute effects of NTG. In aortic insufficiency, sublingual NTG has only minor effects on left ventricular volumes, heart rate and cardiac output. A moderate reduction in pressures results in a significant reduction of wall stress, while there is no major change in regurgitant fraction.

Aortic Valve Insufficiency↗
PubMed1983

[Prognostic value of thallium scintigraphy in diagnostic problem cases].

Quantitative myocardial scintigraphy was performed in 40 patients with a medium prevalence of coronary artery disease (CAD), i.e. in cases with diagnostic difficulties. The results were compared with those of coronary angiography and ventriculography performed within 6 months thereafter. Sensitivity of scintigraphy in 16 patients with CAD was 88% and specificity in 14 individuals without heart disease was 93%. But in 10 patients with non-coronary heart disease specificity decreased to 30%. Scintigraphic evidence of ischemia increased specificity to nearly 100% including patients with non-coronary heart disease but sensitivity was reduced to 69%. The results demonstrate that myocardial scintigraphy with 201Tl is useful in cases with suspected CAD if diagnostic difficulties arise during the early phase of investigation. But there are limitations due to a rather high prevalence of non-coronary heart disease in such groups.

Adult↗