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Biomedical subjects

R Mohr

Publications and source records attributed to R Mohr.

At least 109 records · Page 6Linked to original sources
PubMed1983

Calculated preoperative mean left atrial pressure as a guide to volume load at the termination of aortocoronary bypass operation.

The routine use of an arbitrary fixed left atrial (LA) pressure during volume load after aortocoronary bypass operation was compared with use of an individualized postoperative target LA pressure according to a calculated preoperative LA pressure in two groups of consecutive patients. The preoperative LA pressure of each patient was calculated from the preoperative left ventricular end-diastolic pressure (LVEDP) by the formula: mean LA pressure = 1.16 x LVEDP - 8.53. Left atrial pressure, mean arterial pressure, mean right atrial pressure, and cardiac output were measured simultaneously on arrival at the intensive care unit and 60 minutes later. Cardiac index (CI) and systemic vascular resistance (SVR) were calculated from the variables already mentioned. Results indicated a significantly higher CI and significantly lower SVR in patients in whom volume load was aimed at the calculated preoperative LA pressure. It was concluded that the optimal postoperative LA pressure is specific for each patient and depends on the preoperative LVEDP.

Adult↗
PubMed1983

High-dose MTX/5-FU and adriamycin for gastric cancer.

In a phase II trial we tried to evaluate the efficacy of a sequential combination of high-dose methotrexate (MTX) and 5-fluorouracil (5-FU) combined with Adriamycin (ADM). In a pilot study we had found high-dose MTX effective as a single agent in gastric cancer. MTX and 5-FU were combined sequentially because Cadman et al had shown synergism for this combination. The therapy protocol consisted of high-dose MTX, 1.5 g/m2 of body surface, and high-dose 5-FU, 1.5 g/m2. MTX was administered 1 hr prior to 5-FU. Both drugs were given as a bolus. Twenty-four hours after MTX administration, citrovorum factor rescue was started, 15 mg/m2, q.6h. X 12, orally. Forty-eight hours after MTX administration, serum concentration of the drug was measured by high performance liquid chromatography (HPLC). Fourteen days after MTX was given, ADM, 30 mg/m2, was injected as a bolus. This protocol was repeated every 28 days. Patients eligible for this treatment should have a creatinine clearance of greater than 60 ml/min. The study included 30 patients with metastasizing gastric cancer and performance status between 40% and 70%. The response rate was 63% (19 of 30 patients). Two of 30 patients had complete remissions, which are still maintained. The median survival for responders is not yet evaluable: 68% are living after 17+ mo. The median survival for nonresponders was only 5 mo. The difference in survival curves is significant at a level of p less than 0.05. Cytostatic treatment was well tolerated. Fifty percent of the patients could be treated on an outpatient basis. Total alopecia was observed in only 10% of the patients. Severe leukopenia, thrombocytopenia, and kidney disorders were not observed.

Adult↗
PubMed1982

[Chemotherapy schedule for the management of metastasizing gastric cancer. Methotrexate, adriamycin and 5-fluorouracil].

The possible effectiveness of methotrexate, 5-fluorouracil and adriamycin was tested in a phase I/II study of patients with metastasising gastric carcinoma. complete of partial remission occurred in 19 of 30 patients (approximately 63%). Two of 30 patients had complete remission. Median survival time of patients with remission cannot as yet be determined: about 68% are still alive after 17 months. Median survival time of patients with advanced tumour was only five months. The difference in survival curve is statistically significant (P less than 0.05). The study is continuing.

Adult↗
PubMed1982

Treatment of nocturnal angina with 10 degrees reverse Trendelenburg bed position.

The effect of 10 degrees reverse Trendelenburg tilt of the bed was studied in ten patients with refractory nocturnal angina on 2 consecutive nights before aortocoronary bypass surgery. For the control night the bed was placed in the semi-orthopnoeic position, and for the test night it was put in the reverse Trendelenburg position. This position significantly reduced central venous pressure, diastolic pulmonary artery pressure, the number of isosorbide dinitrate tablets taken sublingually, and the number of angina episodes per night. Reverse Trendelenburg tilt of the bed therefore seems effective for relief of nocturnal anginal pain.

Aged↗
PubMed1982

Enhanced protection of myocardial function by systemic deep hypothermia during cardioplegic arrest in multiple coronary bypass grafting.

The effectiveness of deep systemic hypothermia (20 degrees C) in myocardial protection during aortic cross-clamping was elevated. Seventy-one consecutive patients undergoing coronary artery bypass grafting were divided into two groups. In group A (32 patients) systemic temperature was reduced to an average of 26.8 degrees C (range 24 degrees to 28 degrees C) and the amount of cardioplegic solution infused totalled 1,000 to 1,200 cc. In Group B (39 patients) systemic temperature was reduced to an average of 20.8 degrees C (17 degrees to 23 degrees C) and the total amount of cardioplegic solution infused was 100 to 300 cc. The mean number of coronary (distal) anastomoses per patient was 4.46 in Group A and 4.51 in Group B. There were no surgical deaths, perioperative infarcts, or neurologic damage in either group. Postoperative catecholamine dependence was used as an indicator for inadequate myocardial protection. Catecholamine support was required by 18 patients (56.25%) in Group A and two patients (5.13%) in Group B (p less than 0.0001). Patients of both groups who received five or six coronary anastomoses, whose aortic cross-clamp time was 60 minutes or more, and whose preoperative left ventricular ejection fractions were above 50% were compared: Ten of the 11 (91%) in Group A required catecholamine support as opposed to none of the 12 in Group B (p less than 0.0001). No significant difference in the incidence of catecholamine requirement was found between patients of both groups whose aortic cross-clamp time was less than 60 minutes (2/13 patients in Group A and 2/21 patients in Group B), regardless of their preoperative left ventricular ejection fraction. We conclude that when aortic cross-clamp time exceeds 60 minutes, that is, when multiple distal anastomoses are performed, deep systemic hypothermia is a simple and effective method for myocardial preservation.

Adult↗
PubMed1981

Prevention of supraventricular tachyarrhythmia with low-dose propranolol after coronary bypass.

Eighty-five patients receiving long-term propranolol therapy were randomized after aorta-coronary bypass grafting either to receive minidose propranolol (Group I) or to serve as controls (Group II). They were compared with 18 patients (Group III) who did not receive beta blocking agents prior to operation but were given propranolol postoperatively. Poor-risk patients (those having left ventricular aneurysms, low ejection fraction, or congestive heart failure) as well as patients who required catecholamines postoperatively were included in the study. All three groups were comparable with respect to all risk factors. Propranolol (5 to 10 mg/6 hr) was started through a nasogastric tube 6 hours after operation and continued orally in all patients in Groups I and III. Supraventricular tachyarrhythmia appeared in two of 37 patients in Group I (5%), 19 of 48 patients in Group II (40%), and five of 18 patients in Group III (27%). The incidence of supraventricular tachyarrhythmia was significantly lower in Group I than in Groups II and III (p less than 0.001, Group I versus Group II; p less than 0.01, Group I versus Group III). In conclusion, low-dose propranolol is very effective in preventing supraventricular tachyarrhythmia following aorta-coronary bypass in patients receiving beta blockers preoperatively. The increased tendency for postoperative supraventricular tachyarrhythmia to develop in these patients is attributed to hypersensitivity to adrenergic stimulation after propranolol withdrawal. The tachyarrhythmia can be prevented by early reinstitution of propranolol in low doses after the operation.

Administration, Oral↗
PubMed1981

The drop of residual right ventricular pressure 24 hours after conservative infundibulectomy in repair of tetralogy of Fallot.

Because of late complications such as right ventricular (RV) dysfunction and sudden death after tetralogy repair, a modification in the technique of total repair of tetralogy of Fallot is sought. In this study a shorter than usual conal incision and limited division of only the parietal muscle bands were utilized in 17 patients. The mean RV pressure at the end of the operation was 84 mm Hg; 24 hours later it had dropped to 55 mm Hg. The mean RV/LV pressure ratio at the end of the operation was 0.85, and 24 hours later it was 0.48. Pressure measurements were also taken at the end of the operation, at four predetermined points along the RV outflow tract. It was found that 40% of the average residual obstruction was located at the level of the infundibular ostium, 50% at the level of the conus, and 10% at the pulmonary valve. It is concluded that a 40% drop in the RV/LV pressure ratio can be anticipated to occur in less than 24 hours in cases in which (1) the contractility of the infundibular ostium and conus is preserved by conservative infundibulectomy and (2) there is a residual obstruction at a muscular level. This is on condition that the passage between the crista and the anterior conal wall is of adequate size.

Adolescent↗
PubMed1977

[Allorosettes after renal transplantation in inbred strains of rats (author's transl)].

33 renal transplantations in the isohistogeneic rat strains DA/Han and BDE/Han were performed. The transplanted animals were killed at different days after transplantation and the following dates investigated: 1. number of rosette forming spleen cells with donor erythrocytes, calculated for 10,000 spleen cells and to the total number of extracted spleen cells, 2. haemagglutinin titers with donor erythrocytes. 3. titers of serum IgG, 4. Total number of spleen cells, weight of spleens, weight and volumes of kidney transplants and the number of peripheral blood lymphocytes and granulocytes. The results deomonstrate that the method of immunocytoadherence as described by BIOZZI and ZAALBERG in xenogeneic transplantation systems can also be used in allogenic systems. The course of the immune response was biphasic. Quantitation of allorosette forming cells can be considered as a paramter of allograft rejection. The current literature as to the T- or B-cell specificity of rosetting cells is discussed.

Animals↗
PubMed1977

[Modification of urea-N and creatinine levels using need-adapted amino acids during parenteral nutrition in patients under intensive care].

The present retrospective study concerns two sub-groups of patients having normal serum creatinine levels, adequate 24-hour urine volumes and no pathological changes in the serum or urine osmolarity. There are differences in the initial values of the serum urea nitrogen, the higher (with almost 60 mg%) being already in the azotemia range. Both sub-groups received 100 g of an amino acid mixture adapted to requirements in addition to comparable parenteral nutrition. This did not lead to non-physiological changes in urea nitrogen or any of the other parameters measured in either of the groups. The findings obtained allow the following conclusions to be drawn: Parenteral administration of a quantity of essential and non-essential amino acids adapted to requirements did not bring about a rise in urea nitrogen in either the patients with normal or raised urea nitrogen values. Hence there are not grounds for assuming that in the post-operative or post-traumatic phase the use of a mixture of essential amino acids is necessary to reduce potentially occurring azotemia.

Adult↗