Biomedical subjects
Publications and source records attributed to W Koller.
The effect of clonidine treatment (average dose 0.4 mg/day) was investigated in 10 patients with essential tremor in a double-blind placebo-controlled design. Tremor amplitude and frequency were recorded with an accelerometer. Tremor was not significantly altered by clonidine therapy. Side effects were common. It is concluded that clonidine is not effective treatment for essential tremor.
Controlled parallel experiments were performed on the Vienna test model for the evaluation of procedures for hygienic hand-disinfection in three laboratories (Vienna, Mainz, Birmingham). The degerming activity of four procedures, each taking 1 min, was assessed repeatedly and compared with that of a standard disinfection procedure (ST) using isopropanol 60% (v/v). The mean log reductions (mean log RF) for each procedure were as follows: n-propanol 50% (v/v) 4.85 and 5.14 in Vienna (V) and Mainz (M) respectively, ethanol 70% (v/v) + chlorhexidine-gluconate 0.5% (w/v), 4.01 (V), 3.76 (M) and 4.00 in Birmingham (B). Washing procedures were less effective, mean log RF's of 3.19 (V), 3.49 (M) and 3.04 (B) were obtained with povidone-iodine soap, and 2.91 (V), 3.37 (M) and 3.27 (B) with a liquid phenolic soap. Analysis of variance on the data from Vienna and Mainz revealed significant differences of means not only between procedures ('preparations') but also on repeat testing. To compensate for the influence of variables such as test subjects, laboratory and day, the Vienna test model provides a method of standardization by testing a ST in parallel with the test procedure (P). Standardization of the results was obtained by pair-wise substraction, log RFPi-log RFSTi. Analysis of variance on the resulting values demonstrated that comparability of the results between laboratories and on repeat testing was achieved. The relative variation of the measurements within the laboratories ranged from 0.9 to 4.2%. As assessed by power-analysis, a disinfection procedure will be detected as significantly (P = 0.1) inferior to the standard processes in 95 of 100 experiments if it produces a mean log RF that is at least 0.55-0.65 log units smaller than that of the standard.
Isotonic muscle strength measured by a quantitative technique was decreased in early Parkinson's disease compared to age-matched controls. Weakness was present both on the affected and unaffected side in hemiparkinsonism. Similar degrees of weakness occurred in limbs with tremor or rigidity. Muscle weakness appears to be a primary symptom of Parkinson's disease which may relate to disturbed motor programming due to basal ganglia dysfunction.
We studied 18 patients with essential tremor for difficulty with handwriting, drinking, eating, fine manipulations, and embarrassment. Propranolol and primidone reduced the amplitude of both postural and kinetic tremor. Handwriting, drinking, and eating were improved with therapy, but fine manipulations and motor performance on tapping and pegboard tests were unaltered. Embarrassment remained unchanged. Essential tremor is not a benign condition; disability can be only partly reversed with drug therapy.
In patients with essential tremor, a direct relationship was found between hand dominance and severity of hand tremor. A higher incidence of left-handedness was found in patients with essential tremor than in controls.
We studied chronic oral propranolol therapy and placebo in seven patients with essential voice tremor. Mean scores for voice tremor and voice quality did not differ for placebo or propranolol. Hand tremor amplitude decreased significantly with propranolol. Voice tremor seems to be more resistant to propranolol therapy than hand tremor.
We examined 100 alcoholics who had had no alcohol for more than 21 days, 100 controls, and 50 patients with essential tremor. Three percent of the controls and 47% of the alcoholics had a postural tremor. Alcoholic tremor was never severe, and functional disability occurred in only 17% of patients. There was no relation to age or duration of drinking, and only 1% of the alcoholics had a family history of tremor compared with 46% in essential tremor. Tremor frequency was significantly greater in the alcoholics than in essential tremor. Propranolol therapy decreased tremor more in the alcoholics than in essential tremor. The tremor of chronic alcoholism differs from essential tremor.
An intravenous infusion of a 250-ml, 10% ethanol solution decreased dystonic scores in five of seven patients with spasmodic torticollis, but had no effect in patients with Meige syndrome, tardive dystonia, or generalized torsion dystonia. Alcohol may temporarily decrease some forms of dystonia.
The addition of a continuous Flow System to the circuit of a volume cycled respirator results in an additional IMV option and shows excellent performance for this purpose. The insertion of a bacterial filter into this modified circuit resulted in a dangerous increase of airway pressures after 54 "running hours" for that filter. Test series revealed an insufficient air transmission through the filter, caused by the water vapour-saturated inspiratory gas mixture, which is necessary in long term ventilation. Furthermore it was demonstrated that wet bacterial filters cause malfunction of SIMV systems due to interference with the demand valve responsible for proper air supply. The routine use of a bacterial filter placed in the expiratory branch results in higher risks in an already risky artificial ventilation system and use-nonuse relationships seem to be questionable.
In a retrospective study 40 ICU patients, all underwent Continuous Arteriovenous Hemofiltration (CAVH) for acute pulmonary, acute renal insufficiency or both, were evaluated for lung function parameters and fluid balance. It could be shown that a group of patients suffering from pulmonary insufficiency and with a history of major trauma or obstetric complications mainly benefits from fluid control by means of CAVH, while diuretics were unable to perform the desired action.
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Molindone was compared with haloperidol in animal models of tardive dyskinesia. Treatment with molindone for 14 days at 3, 6, 20 and 40 mg/kg, enhanced the stereotyped behavioral response induced by apomorphine and increased the numbered of D-2 dopamine receptors in the striatum (Bmax) labelled by high affinity (Kd = 40 pmol) binding or [3H] spiroperidol in the guinea-pig. Molindone at 1 mg/kg, caused no behavioral supersensitivity or change in the binding of dopamine receptors. Chronic administration of haloperidol (0.1, 0.5 and 5.0 mg/kg) also increased both the behavioral response to apomorphine and the number of dopamine receptors. Haloperidol, at 0.02 and 0.004 mg/kg, had no effect. Molindone potentiated dopaminergic activity in animal models in a similar way to other neuroleptics, suggesting that its use may also result in tardive dyskinesia.
High-frequency pulsation (HFP), a modified high-frequency jet ventilation (HFJV) technique, was applied intraoperatively as an alternative to conventional inter mittent positive-pressure ventilation in 16 patients undergoing major thoracic operations. Gas exchange and hemodynamic stability were maintained at a frequency of 300 cycle/min. Surgical maneuvers were easier because the lungs were almost completely immobilized.
Methods currently recommended for quantitative bacteriological sampling of surfaces usually suffer from either unreliable results (plain swabbing techniques and contact cultures) or high expenses in terms of material, equipment and/or labour (rinse techniques using sampling fluids). Therefore, a modified swab-rinse technique (SRT) was devised as a reasonably precise and simple alternative: A small amount of sampling fluid (1.5 ml), which can contain neutralisers, is transferred onto the flat surface under investigation; with this fluid and a pre-moistened small cotton-swab an area of 3 cm diameter is thoroughly washed for 15 s. Then 0.1 ml- and 0.5 ml-amounts of the washliquid are collected with automatic microliter pipettes and transferred and spread onto Casein-Soy-Agar for enumeration. In parallel experiments with contact cultures (rodac plates), the new SRT up to 3000 cfu per sample exhibited a linear answer to increasing inocula of E. coli on tiles (Fig. 1, rings). Rodac-plates proved to possess a rather limited span of reliable counts: above 100 colonies, increasing numbers of bacteria were prevented from forming distinguishable colonies (Fig. 1, dots and +es); thus, colony counts higher than 100 on rodac plates cannot be expected to be true estimates. In addition, in the higher count range the results of a common, simplified counting technique differed markedly from results of true counts (Fig. 2). Both methods were equally sensitive in detecting low counts of bacteria (Fig. 1, Fig. 3). Shake-rinse techniques using high volumes of sampling fluid provide lower sensitivity than contact cultures or the new SRT: The use of 100 ml of sampling fluid (15) and plating of 0.1 ml- or 1.0 ml-aliquots of sampling fluid keeps the threshold for detection of bacteria as high as 1000 and 100 per sample, respectively (Fig.3); nevertheless, sensitivity of shake-rinse techniques can be increased by filtration of the whole sample. Thus, the new swab-rinse technique combines several advantages: wide span of true estimates since washliquid can be diluted for enumeration of high counts; high sensitivity ( = ability to detect small numbers of testbacteria in sample) since about one half of the sample is plated; good recovery of testbacteria from both smooth and coarse surfaces; simplicity; the new swab-rinse technique requires basic laboratory equipment and ordinary media and no shaking- or filtration devices; option for immediate and strong neutralisation of disinfectant residues; the sampling fluid can contain any neutraliser; option for automated colony counts since any kind of petri-dishes can be used for culture.
At the occasion of the usual preparations preceding gynecological operations the average vaginal bacterial release of 42 patients, already anaesthesized, was assessed by a rinsing technique to be 5,04 +/- 0,98 log10 c.f.u. per ml sampling fluid after aerobic and anaerobic culture. The reduction of this bacterial release caused by the measurement itself is relatively small, therefore the technique was found to be suitable for evaluation of the efficacy of germreducing measures like irrigation or disinfection. An irrigation with isotonic saline during 30 s was measured to reduce the vaginal bacterial release by 0,4 +/- 0,5 log-steps. A solution containing 0,08% chlorhexidine gluconate + 0,1% benzalkon gluconate applicated during 5 min caused a reduction of 1,04 +/- 0,76 and a watery solution of povidone-iodine one of 2,29 +/- 1,00 log-units when used for 3 min. When after disinfection the sustained antimicrobial action of the chlorhexidin-containing preparation was not neutralized already during the sampling process by Tween 80 + lecithine + histidine being contained in the sampling fluid, an erroneously optimistic log reduction of 2,35 +/- 0,48 was measured. From the results it was calculated that 17-23 volunteers are necessary in order to detect with sufficient statistical safety an observed mean log reduction to be 0,5 log-units smaller than a hypothetical minimal reduction of 2,00 log-steps as required provisionally on an arbitrary basis.
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Pulmonary lesions following extracorporeal circulation (ECC) are said to be responsible for decreased functional residual capacity (FRC). Weaning from controlled mechanical ventilation (CMV) in the postoperative period is commonly performed by a CPAP system in order to restore the impaired oxygen exchange. Testing the superiority of CPAP against insufflation at atmospheric pressure (ZEEP), 33 patients after coronary bypass grafting (CABG) underwent from the end of CMV till extubation either CPAP or ZEEP in a randomized distribution. Data sampling included respiratory rate, paO2, paCO2 and AaDO2-Quotient (gas exchange), as well as HR, MAP, CVP and LAP (hemodynamics). None of the obtained data showed statistical significant differences between the CPAP and the ZEEP group. Therefore there appears to be no necessity for CPAP when weaning CABG patients, due to the absence of previous lung damage and the short time range of intubation and CMV.