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Biomedical subjects

W Dick

Publications and source records attributed to W Dick.

406 records · Page 23Linked to original sources
PubMedDate not supplied

[Different information patterns and their influence on patient anxiety prior to dental local anesthesia].

In 240 patients the correlation between different patterns of pretreatment verbal information on local anesthesia and perioperative patient anxiety was studied. Emphasis has been placed on the importance of "local anesthesia" itself as an anxiety factor as compared with other dental treatment measures and on legal aspects. The 240 patients were randomized into 3 groups of 80 patients each receiving minimum, basic, or extended information on local anesthesia. Anxiety was measured using the STAI test before and after the delivery of information, after local anesthesia, and finally after dental treatment. The significance of different anxiety factors was assessed with a questionnaire. Local anesthesia, pain sensation, and drilling were found to be the main anxiety factors. Higher STAI scores were observed in women and prior to surgical treatment, and the scores increased after minimum and extended information. Anxiety decreased after basic information, and significantly so in patients with high preoperative STAI scores. Disregarding the forensic aspects, our results suggest that basic information prior to dental treatment could be a useful method for reducing anxiety and improving the patients' confidence in the dentist or surgeon.

Adult↗
PubMedDate not supplied

Influence of barbotage on block characteristics during spinal anesthesia with hyperbaric tetracaine and bupivacaine.

Barbotage is the aspiration of the injected volume back into the syringe followed by reinjection twice, with 0.5 ml increases in each aspirated volume. The effects of this technique versus injection without barbotage, on the spinal anesthetic spread of 0.5% tetracaine or 0.5% bupivacaine in 5% glucose 4 ml each, were investigated in 80 men undergoing urologic surgery. The local anesthetic solutions were randomly injected into four groups of 20 patients each, and the anesthetic profile of each solution was then evaluated in a double-blind fashion for the two techniques (barbotage/without barbotage) by an independent observer. In the tetracaine groups, barbotage was associated with a higher dermatome level and shorter time to reach this compared with tetracaine without barbotage. Barbotage caused the latency of bupivacaine to be shorter, but the actual time difference was small and clinically not relevant. Comparing tetracaine and bupivacaine, tetracaine with barbotage achieved a higher segmental level. Time to highest dermatome, however, was shorter for bupivacaine with barbotage compared with tetracaine with barbotage. Barbotage shortened the onset of 3+ motor block with bupivacaine. This difference was statistically significant. Results suggest that barbotage is useful to shorten the time for full development of analgesia when using 0.5% hyperbaric tetracaine. Barbotage with 0.5% hyperbaric bupivacaine, however, has the advantage of intensifying and shortening the onset time of a complete motor block.

Aged↗
PubMedDate not supplied

[General anesthesia or peridural anesthesia in primary cesarean section; a comparative study].

In a prospective cooperative study of gynecologists, anaesthesiologists and pediatricians we compared the effect of continuous epidural anaesthesia (23 cases) and of general anaesthesia (24 cases) on mother and newborn. All patients were delivered in the 39. to 41. week of an uncomplicated pregnancy by primary caesarean section for breech presentation or disproportion. Nearly one third of the patients with epidural anaesthesia showed an initial transitory decrease in blood pressure- up to 25%. The mean pO2 was higher (155 mmHg) in the group with the general anaesthesia than in the group with epidural anaesthesia (88 mmHg). Corresponding values for pO2 were found in the umbilical artery (22,8 mmHg after general anaesthesia, 16,6 mmHg after epidural anaesthesia). Concerning the pH in the umbilical artery, the better results were obtained in the group with continuous epidural anaesthesia (7,3 versus 7,27). After general anaesthesia 9 children had a one minute Apgar-score below 8 versus 3 children after epidural anaesthesia; five and ten minutes after birth the Apgar scores were practically identical. The neurologic examination 15 min after delivery revealed a pathologic muscle tone in three cases after general anaesthesia and in one case after epidural anaesthesia. After 7 days all children showed a normal neurobehavior. As no severe differences between the two types of anaesthesia in the effect on mother or newborn could be seen, in uncomplicated pregnancies the choice should be left to the mother.

Anesthesia, Epidural↗
PubMedDate not supplied

Results of three different therapeutic groups in Perthes' disease.

Three groups of patients with Legg-Calvé-Perthes disease (LCPD) were treated with the following 3 different methods of treatment: conservative treatment alone; immediate varus osteotomy; osteotomy alone when risk factors occurred. The best results were obtained by the immediate varus osteotomy operation. The risk factors were significantly less in this group. Immediate varus osteotomy probably avoids or reduces the occurrence of risk factors. Immediate osteotomy is not prescribed for all patients because in some the operation would be unnecessary. A good result is often possible by conservative treatment alone. As it is often difficult to classify the patients into the 4 standard groups defined by Catterall, at the time of onset of the disease, the age of the patient is a critical factor in the decision for conservative versus operative treatment. In our patients risk factors were significantly less in children younger than 6 years of age, and good results were found in 80% of these patients in Group I with conservative treatment alone. Since 1976, the following procedure has been used: conservative treatment (Thomas splint) in patients younger than 6 years of age; immediate varus osteotomy in the older patients.

Braces↗
PubMedDate not supplied

Secretion of neutral and acid DNases in cultivated human lymphocytes after incubation with DNA; possible consequences for inhalation anesthesia.

After incubation with DNA human lymphocytes release neutral and acid DNase activities into the culture medium; the release depends on DNA concentration and time of cultivation. The electrophoretic mobility of the released neutral DNase activity is in accordance with DNase I and the electrophoretic mobility of the released acid DNase activity with DNase II. The released DNase activities do not originate from dead cells and are not influenced by blast cell formation. The anesthetic halothane can inhibit the released neutral and acid DNase activities. Inhalation anesthesia can possibly disturb the correlation between DNA and DNases in human blood.

Anesthesia, Inhalation↗
PubMedDate not supplied

Exogenous and endogenous plasma levels of epinephrine during dental treatment under local anesthesia.

BACKGROUND AND OBJECTIVES: To determine serum levels of catecholamines after local anesthesia for dental treatment, we used tritium-labeled epinephrine as a vasoconstrictor for dental local anesthesia. METHODS: Twenty healthy male outpatients undergoing standardized dental treatment (deep scaling) were studied. In all patients, only one quadrant was anesthetized even though the treatment was performed on all teeth. Two milliliters of articaine 4% (amide anesthetic) with 20 micrograms epinephrine was used as local anesthetic. Of the total epinephrine administered, 1.2% (100 microCi) consisted of tritium-labeled epinephrine. Blood samples were drawn through a central venous catheter before and at frequent intervals after the local anesthetic solution was administered. RESULTS: A dramatic increase in exogenous epinephrine was observed in four patients during injection (up to 6937 pg/mL). The other 16 patients demonstrated a continuous increase in applied epinephrine that peaked on average at the 7th minute (631.5 +/- 41.4 pg/mL). A second increase occurred after the beginning of the dental procedure. The mean total epinephrine levels were always higher than those of the applied epinephrine. Extrasystoles were observed in two of four and tachycardia in three of four patients with high plasma levels of applied epinephrine. Increases in total epinephrine were associated with exogenous catecholamine administration, whereas the dental treatment did not significantly influence the plasma levels. CONCLUSION: Despite aspiration in 20% of the patients, an unintended intravascular injection occurred. Although healthy young men tolerated large increases in central plasma epinephrine levels surprisingly well, this may not be the case in patients with concurrent cardiovascular disease. Patients at cardiovascular risk should be under continuous monitoring when an epinephrine-containing solution is applied.

Adult↗
PubMedDate not supplied

[Evaluation of a German version of WOMAC (Western Ontario and McMaster Universities) Arthrosis Index].

The WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index is a tested questionnaire to assess symptoms and physical functional disability. We adapted the WOMAC for the German language and tested its metric properties, test-retest reliability and validity in 51 patients with knee and hip OA. All WOMAC scales (pain, stiffness, function) were internally consistent with Cronbach's coefficient alpha ranging from 0.80 to 0.96. Test-retest reliability was satisfactory with intraclass correlation coefficients ranging from 0.55 to 0.74. All scales and the global index calculated as the mean of scale scores had a bimodal distribution and a slight ceiling effect. As hypothesized the WOMAC scales were associated with radiological OA-severity and limitations of range-of-motion. Patients with more severe symptoms and functional disability perceived more limitations in their roles at home and at work. The presented German version of the WOMAC is a reliable and valid instrument for the assessment of symptoms and physical functional disability in patients with knee and hip OA.

Activities of Daily Living↗