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Biomedical subjects

R Krause

Publications and source records attributed to R Krause.

At least 73 records · Page 4Linked to original sources
PubMed1997

[Safe handling of the laryngeal mask airway in eye surgery].

BACKGROUND: We prospectively used the laryngeal mask airway (LM) in eye surgery to evaluate: 1) the limits of safe handling; 2) the feasibility of its use in long operative procedures, and 3) whether patients with higher anaesthetic risk (hypertension, asthma, children) may profit from the LM. METHODS: In 792 patients leak pressure, cuff volume, duration of anaesthesia, and complications were noted; 33 were children under 10 years of age, 100 had hypertension or severe asthma. In 54 patients cuff volume was increased to measure its influence on leak pressure; in 241 leak pressure was also measured at the end of the procedure; in 31 cuff pressure was measured under standard conditions over time; in 7 dead space was evaluated with the BANALYZER program; and in 300 blind endotracheal suction was attempted through the LM. RESULTS: Limits for the safe use of the LM were a leak pressure < 12 cm H2O combined with insufficient spontaneous ventilation (CO2et > 7 vol.%; n = 14), dislocation with gastric inflation (n = 2), and bronchial secretions (n = 1), as blind suctioning of the trachea through the LM was possible in only 1 out of 300 attempts. These limits could be recognised before the start of the operation in most cases. Laryngospasm or closure of the glottis (n = 36, 4.5%) was treatable and did not necessitate abandoning the use of the LM. Mean leak pressure was 17.7 +/- 4.8 cm H2O, showing a comparable distribution in adults and in children and being improved mainly by position changes of the LM, but not by changes in cuff volume. No gas leak occurred when the individual peak inspiratory pressure was equal to or lower than the measured leak pressure except in children. Dead space was almost halved by the LM compared to a face mask (90 +/- 13 vs. 162 +/- 31 ml; P < 0.05), allowing spontaneous breathing to be adequate even when manual assistance of ventilation was not possible (n = 14, 1.8%). In patients with sufficiently high leak pressures, the LM was safely used for long operations (up to 240 min), as leak pressure did not change over time. When only a low leak pressure could be achieved, deep breaths could be delivered by prolongation of the inspiratory time, thereby preventing atelectasis if tidal volume was limited. Cuff pressure rose to about 100 cm H2O within 60 min and should be monitored. In children, air was aspirated intermittently out of the stomach in procedures longer than 30 min; in adults, we monitored and buffered gastric contents where necessary. In patients at risk, the LM stimulates the circulation and bronchial reactivity less than an endotracheal tube. Children could be discharged earlier from the recovery room (0.45-1.5 h vs. > or = 2 h after neuromuscular relaxation and intubation). CONCLUSION: Limits for the use of the LM in eye surgery are delineated. Within these limits, the LM offers control over the airway comparable to that of an endotracheal tube with less stimulation. The LM has to be applied by an experienced user, and has advantages in eye surgery.

Adolescent↗
PubMed1996

Seven-day triple therapy with lansoprazole, clarithromycin, and metronidazole for the cure of Helicobacter pylori infection: a short report.

BACKGROUND: To refine our understanding of anti-Helicobacter pylori treatment regimens further, we evaluated the efficacy and safety of lansoprazole given in combination with clarithromycin and metronidazole for 7 days in an open-label, multicenter study. MATERIALS AND METHODS: H. pylori-positive patients self-administered lansoprazole, 30 mg; clarithromycin, 500 mg; and metronidazole, 500 mg bid for 7 days. Patients were assessed at pretreatment, at which time the presence of H. pylori was documented by rapid urease test or histology and culture, following study drug administration (week 1) for a brief evaluation only, and at least 4 weeks posttreatment (week 5), including endoscopy with collection of biopsy specimens for culture and histology testing. RESULTS: Of the 60 patients enrolled in the study, 59 had confirmed H. pylori infection, and 51 were included in an intent-to-treat analysis of efficacy. Primary metronidazole and clarithromycin resistance were observed in 84% and 8% of study patients, respectively. One month after the end of therapy, H. pylori infection was cured in 40 of 51 patients (78%); 95% confidence interval, (65%-89%). The triple-therapy regimen was well-tolerated, with only 2 patients (4%) requiring premature withdrawal from the study due to treatment-related adverse events. Taste perversion (15.0%) and diarrhea (11.7%) were the most frequently reported adverse events possibly or probably related to study medication during the treatment period. CONCLUSION: Despite a high prevalence of metronidazole resistance, a 1-week, triple-drug combination of lansoprazole, clarithromycin, and metronidazole is effective treatment for and well-tolerated by patients with H. pylori infection.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1996

[Remembering and acting out].

In the accompanying paper two fifteen-hour psychoanalytical therapies were investigated with regard to the temporal distribution of Luborskian relationship episodes and the facial expressions of both protagonists. The two therapies were taken from a sample of eleven treatments: one had had the most success; the other, the least. The investigation focussed on what type of interaction between the recollective narration of past relationships and the present form of relationships could be expected, and whether the relation between these two would be dependent upon the success of the therapy. The hypothesis that a parallel processing of the narrated episode and the exhibited emotion would occur within the patient could not be confirmed. The frequency of recollective narration correlated negatively--in line with a hypothesis of Freud's--with the frequency of exhibited emotions. In the successful treatment, however, the therapist exhibited the emotions which one would have expected the patient to show. The results are discussed in terms of a theory of the psychotherapeutical process and containing.

Acting Out↗
PubMed1995

Toxicity of sulfonamide-reactive metabolites in HIV-infected, HTLV-infected, and noninfected cells.

It has been suggested that the high rates of adverse reactions to sulfonamides among patients with AIDS may be related to an increased sensitivity to reactive drug metabolites among HIV-infected cells. To study this hypothesis, we investigated the toxicity of the hydroxylamine of sulfamethoxazole in HIV-infected and noninfected MOLT-3 cultured human T-lymphoblasts. Toxicity was assessed by trypan blue dye exclusion. The hydroxylamine of sulfamethoxazole produced concentration-dependent toxicity in HIV-infected cells, with marked toxicity seen when HIV-infected cells were incubated with 400 microM of the hydroxylamine (82 +/- 8%); this was significantly greater than the toxicity seen among noninfected cells (p < 0.01). There was no concentration-dependent toxicity seen among noninfected cells or in cells infected with HTLV-I, suggesting that the concentration-dependent toxicity seen was specifically related to HIV infection. HIV-infected cells had significantly lower glutathione concentration than did noninfected cells (p < 0.05). Incubation with the hydroxylamine of sulfamethoxazole produced a concentration-dependent decline in glutathione content that was similar in infected and non-infected cells. Co-incubation with glutathione or N-acetylcysteine significantly reduced the toxicity of hydroxylamine of sulfamethoxazole in HIV-infected cells (p < 0.05). Our data supports the role of reactive sulfonamide metabolites in the pathogenesis of adverse reactions to sulfonamides among patients with AIDS.

Adult↗
PubMed1995

Time-course of toxicity of reactive sulfonamide metabolites.

It has been suggested, on the basis of work in cell-free systems, that sulfonamide hydroxy-lamines are metabolized to nitroso metabolites which may be the proximate toxins mediating sulfonamide hypersensitivity reactions. We performed time-course experiments investigating the toxicity of the hydroxylamine and nitroso derivatives of sulfamethoxazole to investigate this hypothesis. The nitroso derivative of sulfamethoxazole was significantly more toxic than the hydroxylamine derivative (P < 0.05). When the LC50 was compared over time, there was a significant decrease in the LC50 of the hydroxylamine of sulfamethoxazole over time, while there was no change in the LC50 of the nitroso derivative. There was an equivalent reduction in toxicity demonstrated when the hydroxylamine or nitroso derivatives were co-incubated with glutathione. This supports the role of the nitroso as a proximate toxin mediating sulfonamide hypersensitivity reactions and suggests an explanation for the high rate of adverse reactions to sulfonamides among patients with AIDS.

Cell Survival↗
PubMed1994

[Loss, grief and depression: considerations based on emotion research].

After clearing up the terminology within the field of bereavement the significance of different types of attachment to the lost object for the mental development after the loss is discussed. Similarities and differences of three phase models of the bereavement process are worked out. The heuristic value of these models is set into balance to the danger of their misuse for nailing down somebody about quality and duration of his "Trauerarbeit". Sadness as an affect is described within an general schema for the understanding and description of emotions. According to this schema affects are depicted internally as specific cognitive structures. The one of the grief affect predisposes to traumatic developments. Intercultural data show that identificatory processes are highly important for a benevolent ending of bereavement processes. The actual tendency to consider such phenomena as pathological is cleared up through a comparison of sadness, depression and depressivity. Departing from different types of attachment, bereavement courses and identificatory processes possible malign endings of bereavement processes are described.

Adaptation, Psychological↗
PubMed1994

Ectopic pregnancy.

The incidence of ectopic pregnancies has increased dramatically over the past 20 years, resulting in significant maternal morbidity and mortality. This article reviews the epidemiology, pathogenesis, clinical manifestations, diagnostic testing, differential diagnosis, treatment, prognosis, and medico-legal considerations in the evaluation of the patient with a suspected or confirmed pregnancy.

Diagnosis, Differential↗
PubMed1993

[Nerve compression syndromes in sports climbers].

Among 119 sports climbers 18 nerve compression syndromes were found. Three climbers with CTS were examined in MR imaging to identify anatomical or pathological structures which could cause the symptoms of CTS.

Adult↗
PubMed1992

[The interpersonal alliance as the principle of psychoanalytic therapy].

The classical opinion encountered in psychoanalytic psychotherapy is that the main curative agent is language, i.e. the information proffered by the analysand and the interpretations of the analyst. Over and against this view the author draws attention to the non-verbal structures in the twosome relationship between analysand and therapist. Essential elements of this working alliance, he suggests, operate via non-verbal behaviour. Hence this behaviour needs to be systematically observed and evaluated. His conclusion is that it requires the consideration of non-verbalized fantasies and affects for the therapeutic relationship to develop into a "good relationship".

Affect↗
PubMed1991

Synthesis and biological activity of new HMG-CoA reductase inhibitors. 3. Lactones of 6-phenoxy-3,5-dihydroxyhexanoic acids.

A group of 43 optically active sodium carboxylates (11a-qq and the corresponding lactones 4 were prepared from respective phenols 8 according to Schemes I-III. Phenols 8 were synthesized from commercially available compounds according to Schemes IV-IX. A number of these HMG-CoA reductase inhibitors 11 exceeded mevinolin's activity in vitro (Tables II and III). Selected lactones 4 effectively inhibited hepatic "de novo" cholesterol synthesis in rats in vivo (Table IV). After po administration to rabbits, 4ff(11ff), 4hh, and notably 11jj reduced plasma cholesterol levels more potently than mevinolin (Table V). Whereas 4ff(11ff) displayed the slight superiority expected according to in vitro data, 4hh and 11jj were considerably more potent than expected. Each of these compounds had only moderate activity after po administration to dogs (Table VI). Compound di-11ii, a hybrid of the structural elements of probucol and HMG-CoA reductase inhibitors, after po administration to rats decreased serum lipoproteins and increased HDL/LDL ratio better than probucol (Table VII). HMG-CoA reductase inhibitor 11ll and phenolic building blocks 8, notably 8jj and 8kk, inhibited LDL oxidation in vitro (Table VIII). Chemical structure-activity relationships (Table IX) and the pharmacological profile of phenoxy-type inhibitors 11 diverged from those of known HMG-CoA reductase inhibitors.

Animals↗
PubMed1990

Synthesis and biological activity of new HMG-CoA reductase inhibitors. 1. Lactones of pyridine- and pyrimidine-substituted 3,5-dihydroxy-6-heptenoic (-heptanoic) acids.

Lactones of pyridine- and pyrimidine-substituted 3,5-dihydroxy-6-heptenoic (-heptanoic) acids 2-4 have been synthesized. Extensive exploration of structure-activity relationships led to several compounds exceeding the inhibitory activity of mevinolin (1b) on HMG-CoA reductase, both in vitro and in vivo. First clinical trials with 2i (HR 780) are in preparation.

Acetates↗