Biomedical subjects

R Michael

Publications and source records attributed to R Michael.

At least 19 recordsLinked to original sources

PubMed2005

Successful treatment of sexual disinhibition in dementia with carbamazepine -- a case report.

Sexual disinhibition is a disturbing behavioral symptom in dementia. At present, there are no treatment guidelines available. Here we present the successful use of carbamazepine in a 78-year old AD patient with hypersexual behavior. The efficacy of carbamazepine in this case is in parallels to its effects on aggression and agitation in dementia and supports the important role of anticonvulsants in the management of behavioral disturbances in demented patients.

Aged↗

PubMed2004

Effect of acute brain death on release of atrium and B-type natriuretic peptides in an animal model.

INTRODUCTION: Atrium and B-type natriuretic peptides (ANP and BNP) and big endothelin (ET)-1 are markers for severity of heart failure and may be used in the quality assessment of donor hearts. Elevated cardiac troponins predict early graft failure after heart transplantation. This study evaluated the effects of acute brain death (BD) on the release of ANP, BNP, big ET-1, and cardiac troponins in an animal model. MATERIALS AND METHODS: Pigs were randomized into a BD group (n=5) and a control group (n=5). In the first group, acute BD was induced, and anesthesia was stopped. In the control animals, a sham operation was performed, and anesthesia was continued. Parameters were measured at baseline and for 13 hours postoperatively. RESULTS: After acute BD, there were significant hemodynamic changes. In the control group, the BNP level was higher than in the BD group and decreased over time (P =0.016). There was no significant change in BNP release in the BD group up to 13 hours (P =0.1). ANP release remained stable over time in the control group (P =0.35) but decreased in the BD group (P =0.043). The big ET-1 levels were not different between groups. Cardiac troponin I was elevated in the BD group 5 hours after BD (P< 0.05) but remained under 1.5 mg/L throughout the study. CONCLUSION: Acute BD did not lead to an increase of BNP and ANP levels. Moreover, intact brain function seems to augment the release of natriuretic peptides from the myocardium. Further clinical evaluation of prognostic values of natriuretic peptides for the assessment of donor hearts is necessary. Cardiac troponins are a useful additional tool in the evaluation of donor hearts.

Acute Disease↗

PubMed2003

Uvulopalatopharyngoplasty for sleep apnea in mentally retarded obese 14-year-old: an anaesthetic challenge.

Anaesthetic management of patients with obstructive sleep apnea for upper airway surgery has always been a challenging task. We report our anaesthetic approach for a young, mentally retarded obese patient with documented obstructive sleep apnea undergoing uvulopalatopharyngoplasty. The therapeutic intervention before, during and after operation is discussed.

Adolescent↗

PubMed2002

Epidural buprenorphine in management of pain in multiple rib fractures.

BACKGROUND: Pain from multiple rib fractures may affect pulmonary function, morbidity, and length of stay in the intensive care units. This study describes some clinical characteristics of epidural buprenorphine, a lipophilic and partial opiate agonist with a higher micro receptor affinity than morphine, in combating the pain in multiple rib fractures. METHODS: The study was conducted prospectively over a 15-month period. A total of 27 patients admitted to the hospital with multiple rib fractures were studied. Buprenorphine at a concentration of 0.3 mg in 5-10 ml normal saline was administered epidurally, twice daily the first 24 h, thereafter once daily. Ventilatory function tests (including vital capacity, tidal volume, respiratory rate, and minute volume) and assessment of pain intensity using a simple, categorical, verbal rating scale were obtained before and after institution of analgesia. Any nausea, vomiting, hypotension, urinary retention, respiratory depression or pruritus were recorded. RESULTS: We found a significant improvement in ventilatory function tests during the 1st, 2nd, and 3rd day after epidural analgesia when compared with the preanalgesia levels (P < 0.001). Changes in the verbal rating scale demonstrated that epidural buprenorphine was associated with marked improvement in pain at rest and pain during coughing and deep breathing. None of our patients developed hypotension (<10% of the baseline), urinary retention or respiratory depression. Nausea, vomiting, and mild pruritus were the only reported complications. CONCLUSIONS: Epidurally introduced narcotic, like buprenorphine in saline, has been found to be effective in our study to achieve adequate analgesia in treatment of patients with multiple rib fractures. In addition, this methodology of pain relief eliminates the costly delivery system and early discharge, and allows walking epidurals and follow-up on outpatient basis.

Analgesia, Epidural↗

PubMed2001

The impact of work-related trauma on the well-being of perioperative nurses.

Perioperative nurses are confronted daily with the reality of trauma, of experiencing abuse and conflict in the workplace, dealing with practice issues such as gruesome motor vehicle accidents, as well as the heartbreaking tragedy of death (Michael 1999, Michael & Jenkins 2000). This study explored the reported impact of traumatic events upon the well-being of perioperative nurses, using both qualitative and quantitative methods of inquiry. Of the 233 respondents in this study, 161 (69%) reported being exposed to traumatic events. The types of described reactions following trauma were predominantly negative and included negative feelings, negative team member relationship issues, negative behaviour from others, physical concerns and negative working conditions. Intrusion and avoidance behaviour was reported to a significant degree. Performance distress, somatic distress, general feelings of distress and self-related health were significantly poorer in perioperative nurses who had experienced trauma, than their colleagues without such experiences. Conversely, some respondents were able to construe positive outcomes from trauma and grow from the experience. Positive outcomes included gains from the experience, team building, positive feelings and action taken. The current study contributes to understanding of the role of environmental factors, associated work-related trauma and recovery following such events. The outcomes have implications for effective trauma stress management interventions and continuing education of nurses.

Conflict, Psychological↗

PubMed2001

Recovery from work-related trauma by perioperative nurses: the effects of social and personal resources.

The complexities of the recovery process following a traumatic event suggest a need to provide support resources that sustain or promote positive perceptions of the events. The availability and effectiveness of social support is a function of both its content and its capability of responding appropriately to the influence of the recovery dynamics in a contingent manner. Further, the quality of recovery from work-related trauma is suggested to be a function of the interactive processes of the individuals, the organisational environment they work in, and the social support provided. Using methodological triangulaton, 213 nurses working in rural and metropolitan operating suites were surveyed to assess the types, amount and effectiveness of social and personal resources that were used following exposure to traumatic work experiences. The findings demonstrate the significance of personal and social support resources in assisting perioperative nurses to recover from traumatic experiences. A personal sense of coherence and emotional support received through disclosure to work colleagues and supervisors were the most salutary aspects of support following trauma. The results suggest that opportunities should be made available through peer support programs, educational programs and professional meetings to better prepare nurses for traumatic situations and their aftermath. Furthermore, the work organisation needs to be educated in the need for and process of creating sanctuary and providing a holistic approach to management. This will then allow individuals, such as perioperative nurses, to continue to function at an acceptable level during the mitigation of the traumatic incident.

Adaptation, Psychological↗

PubMed2001

Work-related trauma: the experiences of perioperative nurses.

Traumatic experiences in the workplace are an integral part of the role of the perioperative nurse. The atypical nature and characteristics of these experiences is such that perioperative nurses may suddenly encounter reactions and feelings that are very different and more intense than anything they will have encountered previously. Furthermore, these events may increase the risk of them experiencing subsequent trauma stress reactions and place them at risk of profound distress and significantly impaired functioning. A survey of 233 nurses working in rural and metropolitan operating theatres assessed the range and types of traumatic work experiences. Results showed that exposure to traumatic events was reported by 161 (69%) of all respondents and a wide range of traumatic experiences were reported to have affected their well-being. The findings have implications for the formulation of trauma management strategies, both at individual and organisational levels and suggest new directions for education and research in promoting a recovery environment in which perioperative nurses can work.

Adult↗

PubMed2001

Loss of bone mass and vitamin D deficiency after hematopoietic stem cell transplantation: standard prophylactic measures fail to prevent osteoporosis.

Bone mineral density (BMD) and biochemical markers of bone metabolism were analyzed in 67 adults with ALL (n = 27), AML (n = 14), MDS (n = 6) and CML (n = 20) before and after allogeneic stem cell transplantation (SCT). Median age was 36 years (17-56). Twenty-six out of 53 patients (49%) had osteopenia and osteoporosis before SCT, 21/26 had acute leukemias and 5/26 had chronic myeloid leukemia (CML). T-score before SCTwas -1.23 in patients with acute leukemias and 0.62 in CML patients (P = 0.001). After SCT, a significant loss of BMD was observed in all patients. After 6 months, 24 of 36 evaluable patients (67%) had pathologic BMD, 11 of them (30%) had developed osteoporosis. After 12 months, 20 of 32 evaluable patients (62%) had BMD values below normal and nine of them (28%) had osteoporosis. Increased pyridinium excretion was observed in 12/20 patients (60%) with acute leukemias, but only in 3/13 (23%) with CML (P = 0.014). A prolonged vitamin D deficiency for more than 6 months developed early after SCT in all patients. Patients with acute leukemias frequently have osteopenia and osteoporosis before SCT. After SCT, a further loss of BMD occurs independent from the underlying disease. Standard prophylactic measures are not sufficient to prevent loss of bone mass. Studies on prophylactic interventions are needed to prevent severe osteoporosis in long-term survivors of SCT.

Adolescent↗

PubMed2001

Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy.

We evaluated in this prospective study the effectiveness of continuous thoracic epidural anesthesia (TEA) and postoperative analgesia with ropivacaine and compared it with general anesthesia (GA) and opioids for pain relief, side effects, postanesthesia recovery, and hospital discharge after modified radical mastectomy. Sixty ASA physical status II and III patients undergoing mastectomy were randomly assigned to two study groups of 30 patients each. In the TEA group, an epidural catheter was inserted at T6-7, and 5--10 mL of 0.2% ropivacaine was injected to maintain anesthesia and to continuously administer adequate analgesia for 48 h. GA was induced with IV 1--2 mg of midazolam or 50--100 microg/mL of fentanyl followed by 50--150 mg of propofol and was maintained with sevoflurane and 50% N(2)O in oxygen. The Aldrete score system was used to evaluate postanesthesia recovery, a verbal rating scale was used for assessment of pain intensity, and a postanesthesia discharge scoring system was used for discharge home. The demographic data and side effects (except for nausea and vomiting) (GA 43%, TEA 10%, P = 0.0074) and discharge home were similar in both groups. However, the number of patients ready for discharge from the recovery room during the first postanesthesia hour (Aldrete score of 10) was significantly larger after TEA (80%) than after GA (33%) (P = 0.0006). GA patients experienced significantly more (P < 0.001) substantial pain than TEA patients on Day 0 (70%), Day 1 (53%), and Day 2 (27%) after the surgery. Patient satisfaction was greater with TEA (70%) than with GA (30%) (P < 0.001). We conclude that TEA with ropivacaine provides better postoperative pain relief and less nausea and vomiting, facilitates postanesthesia recovery, and gives greater patient satisfaction than GA.

Adult↗

PubMed2001

Lens growth and protein density in the rat lens after in vivo exposure to ultraviolet radiation.

PURPOSE: To investigate lens growth after different doses of ultraviolet radiation (UVR) and to investigate the long-term effect of a near-threshold UVR dose on the refractive index distribution in the lens. METHODS: Sprague-Dawley rats received UVR (lambda(MAX) = 300 nm) unilaterally during a 15-minute period. The exposure dose ranged from 0.1 to 20 kJ/m(2), and the rats were kept for up to 32 weeks after exposure. Intact lenses were photographed and lens wet and dry masses were measured. The protein density was estimated by quantitative microradiography. Freeze-dried lens sections were used for contact x-ray photographs. From the transmission of the microradiographs, protein density and refractive index profiles were calculated along the lens radius with a resolution of 2.5 microm. RESULTS: Lens dry mass in exposed eyes was lower than in nonexposed eyes at one week after exposure. Lens water content was decreased after low UVR doses but increased after high doses. The difference between exposed and nonexposed lenses in dry mass and water content increased with time after exposure. No significant difference was found for the mean protein density in exposed and nonexposed lenses. The protein density increased linearly in the lens cortex, from a minimum in the superficial cortex of 0.26 g/cm(3) to a maximum in the deep cortex of 0.81 g/cm(3). This corresponded to a refractive index of 1.38 and 1.48, respectively. CONCLUSIONS: Lenses exposed to UVR grew more slowly than their nonexposed contralaterals. This growth inhibition was dose dependent. Near-threshold doses led to decreased water content in the lens whereas high doses led to swelling. Six months after near-threshold UVR exposure, no global change of the refractive index was found. However, local variations of the refractive index caused a subtle cortical light scattering.

Animals↗

PubMed2001