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Biomedical subjects

S N Piper

Publications and source records attributed to S N Piper.

47 records · Page 3Linked to original sources
PubMed1999

Comparison of the effects of desflurane and isoflurane anaesthesia on hepatocellular function assessed by alpha glutathione S-transferase.

The purpose of this study was to investigate the influence of isoflurane and desflurane on hepatocellular function. Twenty male patients undergoing elective surgery were randomly assigned to receive either isoflurane or desflurane anaesthesia. Alpha glutathione S-transferase concentrations and aminotransferase activities were measured at induction of anaesthesia (t0), 15 min (t1), 90 min after induction (t2), end of surgery (t3) and 2 h thereafter (t4). A significant increase in alpha glutathione S-transferase concentration was observed only in the isoflurane group. Alpha glutathione S-transferase levels increased significantly from 2.3 microg.l-1 at t0 to 6.1 (1.9) microg.l-1 at t2 and to 7.8 (2.1) microg.l-1 at t3. A significant difference in alpha glutathione S-transferase concentration between the two groups was found at t2 and t3. The significant increases in alpha glutathione S-transferase concentrations in patients receiving isoflurane suggest a transient disturbance of hepatocellular function.

Aged↗
PubMed1999

[Prevention of postoperative nausea and vomiting after hysterectomy with oral dolasetron, intravenous dehydrobenzperidol or a combination of both substances].

OBJECTIVE: PONV is a frequent postoperative complication. The aim of this study was to assess the efficacy of oral dolasetron in comparison to intravenous droperidol (DHB) and to a combination of both drugs for prophylaxis of PONV. METHODS: 80 patients (ASA I-III) were randomly allocated to one of four groups and received the following medication: group A: 50 mg dolasetron was given orally 45-60 minutes before anaesthesia was induced, group B: 2.5 mg i.v. DHB + placebo p.o. was administered while inducing anaesthesia (positive control group), group C: 50 mg dolasetron was given 45-60 minutes before anaesthesia was induced and 2.5 mg i.v. DHB was given while inducing anaesthesia, group D: placebo tablet was administered 45-60 minutes before anaesthesia was induced (negative control group). PONV was assessed using a 5-point score: 0 = no symptoms, 1 = nausea, 2 = retching, 3 = vomiting, 4 = multiple vomiting. Metoclopramid was given as antiemetic if a patient reached two or more score points. RESULTS: PONV scores were significantly lower in group A and C (p < 0.001) compared to the control group. Patients treated with DHB showed a significantly lower PONV score in comparison to the placebo treated patients (p < 0.05). Between the groups A, B and C we found no significantly different PONV scores. Postoperative consumption of metoclopramid was significantly lower in the groups A (2.4 +/- 5.2 mg) and C (1.0 +/- 3.1 mg) than in the placebo group (6.0 +/- 6.8 mg), whereas between group B (3.0 +/- 5.7 mg) and D we found no significant differences. CONCLUSIONS: Single dose of oral dolasetron and single dose of intravenous DHB reduced PONV effectively, in patients undergoing gynaecologic surgery. A combination of dolasetron and DHB has no better effect than a single dose of oral dolasetron. Contrary to DHB the application of dolasetron decreased the postoperative antiemetic requirement significantly.

Antiemetics↗
PubMed1999

The effects of sodium nitroprusside-induced hypotension on splanchnic perfusion and hepatocellular integrity.

UNLABELLED: The purpose of our study was to investigate the effects of sodium nitroprusside-induced hypotension on splanchnic perfusion and hepatocellular integrity. Thirty patients undergoing radical prostatectomy were allocated randomly to a sodium nitroprusside (SNP) or control group (control). Regional pco2 was measured using gastric tonometry, and the regional to arterial difference in partial pressure of CO2 and intramucosal pH were calculated. The cytosolic liver enzyme alpha-glutathione S-transferase and standard liver enzyme markers (alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltransferase) were also measured. Mean arterial pressure in the SNP group was 50 mm Hg for 97 min during surgery. A significant increase from baseline in regional pco2 (from 40.0+/-4.2 mm Hg to 45.3+/-1.3 mm Hg) and regional to arterial difference in partial pressure of CO2 (from 4.1+/-1.1 mm Hg to 9.7+/-1.4 mm Hg) was seen at 90 min after skin incision only in the SNP group. Intramucosal pH decreased significantly from 7.40+/-0.02 to 7.35+/-0.03 during the same period in this group. Tonometric variables returned to baseline values within 2 h postoperatively. Alpha-glutathione S-transferase concentrations increased significantly in the SNP group from baseline to peak concentrations at the end of surgery (SNP: 9.93+/-4.94 microg/L; control: 5.85+/-1.86 microg/L). A return to baseline values was seen 24 h postoperatively. No significant changes in standard liver enzyme markers were seen throughout the study period. It is concluded, that splanchnic perfusion was transiently impaired during controlled hypotension. This is supported by significant changes in tonometric data. Increased serum levels of alpha-glutathione S-transferase may indicate a disturbance in hepatocellular integrity. IMPLICATIONS: We studied gastric mucosal tonometry and the cytosolic liver enzyme alpha-glutathione S-transferase to evaluate the effects of controlled hypotension induced by sodium nitroprusside on splanchnic perfusion and hepatocellular integrity. Splanchnic perfusion decreased and alpha-glutathione S-transferase increased during and after a hypotensive period, but returned to baseline values within the first postoperative day, indicating a transient impairment of splanchnic perfusion and hepatocellular integrity.

Antihypertensive Agents↗
PubMed1999

Continuous heparinization and circulating adhesion molecules in the critically ill.

Endothelial activation and damage are common endpoints of a complex process that may result in multiple organ dysfunction syndrome (MODS). The influence of continuous intravenous heparinization on plasma levels of circulating adhesion molecules was studied in 28 trauma patients (injury severity score between 15 and 25 points) and 28 sepsis patients secondary to abdominal surgery. According to a prospective, randomized sequence the patients received either unfractionated heparin (aim: activated partial thromboplastin time (aPTT) approximately 2 x normal) (trauma-heparin (n = 14); sepsis-heparin (n = 14)) or not (trauma (n = 14); sepsis (n = 14)). Plasma levels of circulating soluble endothelial leukocyte adhesion molecule-1 (sELAM-1), vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (slCAM-1), and granule membrane protein-140 (sGMP-140) were serially measured from arterial blood samples for 5 days. Approximately 600 U/h of heparin were given to increase aPTT to approximately 60 s. Plasma levels of all adhesion molecules increased in all groups. This increase was significantly (p < .05) highest in both sepsis groups (sepsis: sELAM-1: from 50+/-11 to 84+/-19 ng/mL; slCAM-1: 410+/-68 to 700+/-95 ng/mL), but did not differ significantly between the treated and nontreated patients (sepsis-heparin: sELAM-1: from 60+/-131 to 88+/-20 ng/mL; slCAM-1: from 398+/-99 to 686+/-119 ng/mL). Trauma patients showed a less pronounced increase in all adhesion molecules without differences between the two subgroups. Only sGMP-140 increased significantly (p < .05) more in the trauma (from 102+/-20 to 169+/-16 ng/mL) than in the trauma-heparin group (from 109+/-19 to 132+/-17 ng/mL). It is summarized that continuous heparinization with approximately 600 U/h did not attenuate the rise in circulating adhesion molecules in sepsis and trauma patients. The study findings suggest that heparin in this dose regimen may be unlikely to influence endothelial inflammation or endothelial function in critically ill patients.

Adult↗
PubMed1998

[Prophylactic nefopam administration for post-anesthetic shivering].

PURPOSE: Shivering is a frequent postanaesthetic complication. Its definite reason is unknown. Patients with cardiovascular or pulmonary diseases are endangered by postanaesthetic shivering. The aim of this study was to assess the efficacy of nefopam in prophylaxis of shivering. Additionally we investigated the influence of nefopam on haemodynamic parameters and on the time until extubation. METHODS: 30 patients (ASA I-II) were randomly allocated in a double-blind fashion to one of two groups to receive directly after the end of isoflurane application either nefopam (0.15 mg/kg) or placebo (0.9% saline). The period of anaesthesia had to be longer than 60 minutes. All patients received a premedication with lorazepam (0.02 mg/kg) 30-45 minutes prior to surgery. Induction of anaesthesia was standardised: fentanyl (3 micrograms/kg), thiopentone (5 mg/kg), atracurium (0.4 mg/kg). Intraoperatively a mixture of isoflurane, nitrous oxide (60%) and oxygen was used to maintain anaesthesia. The following parameters were evaluated: Age, sex, duration of operation and anaesthesia and the time between the end of application of volatiles and extubation. Heart rate (HR), mean arterial blood pressure (MAP), rectal temperature and O2-saturation were measured at predefined data points. Postoperatively the consumption of analgesic was documented. The severity of shivering was classified in five grades. RESULTS: In the control-group nine patients shivered (60%), whereas in the nefopam group only one patient (6.6%) shivered (p < 0.05). In comparison to the placebo group we observed in the nefopam group a significantly decreased HR 30 and 60 minutes postoperatively (p < or = 0.007 and p < or = 0.002). We did not observe prolonged awakening in the nefopam-treated patients. MAP and O2-saturation showed similar reactions in both groups. CONCLUSION: The data indicate that prophylactic administration of nefopam can suppress postanaesthetic shivering. Prolonged awakening was not observed.

Analgesics, Non-Narcotic↗
PubMed1998

Critical illness polyneuropathy following cardiac surgery.

Critical illness polyneuropathy (CIP), a neurologic complication which may occur secondary to surgery, trauma and coma, is associated with sepsis or multiple organ failure (MOF). CIP is characterized by an axonal distal degeneration of sensory and motor fibres. The patients will often become neurologically conspicuous when weaning from mechanical ventilation is unexpectedly difficult. In such cases electrophysiologic examinations must be performed. CIP following cardiac surgery is widely unrecognized. The most important aspect of CIP therapy is treatment of the underlying disease, because no specific treatment for CIP exists. We report on a 64-year old patient who developed sepsis and CIP following cardiovascular surgery. The neurological complication was initially misinterpreted as hypoxic brain damage.

Anti-Bacterial Agents↗
PubMed1998

[Neurologic symptoms in acute thoracic aortic dissection--a case report].

Acute thoracic aortic dissection is a life-threatening illness. It is often difficult to diagnose preclinically due to its many possible symptoms. One out of three patients has neurological deficits. The prognosis depends on rapid diagnosis and immediate adequate therapy. Therefore, every emergency physician should know the signs and risk factors of this disease. The most important goals of prehospital therapy are management of pain and anxiety and pharmacological control of the systolic blood pressure and heart rate. We report on a 46-year-old female patient who developed neurological deficits caused by an acute thoracic aortic dissection.

Acute Disease↗
PubMed1997

Myxoma complex associated with transient hyperthyroidism: are diseases of the thyroid part of the complex?

The myxoma complex is a very rare disease. We report on a 31-year-old woman who suffered a hyperthyreosis, which resolved spontaneously. A few months later she developed a Cushing's syndrome, caused by a primary adrenocortical nodular dysplasia. A bilateral adrenalectomy had to be performed. 15 months after this operation she developed a cerebral infarction caused by an embolus from a left atrial myxoma. Our patient is a further case of Carney's syndrome. The aspect of the hyperthyreosis is interesting: Perhaps disease of the thyroid represents a new element of Carney's syndrome.

Adult↗
PubMedDate not supplied

Unexpected return of spontaneous circulation after cessation of resuscitation (Lazarus phenomenon)

Since 1982, more than 20 patients with return of spontaneous circulation after cessation of cardiopulmonary resuscitation (Lazarus phenomenon) have been published. We report on another case here. Such cases are probably underreported due to medicolegal concerns. After cessation of resuscitation, each patient should be further monitored for at least 10 min to detect a possible Lazarus phenomenon.

Aged↗