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Biomedical subjects

A Hole

Publications and source records attributed to A Hole.

28 records · Page 2Linked to original sources
PubMed1984

Per- and postoperative monocyte and lymphocyte functions: effects of combined epidural and general anaesthesia.

Monocyte-mediated cytolysis and thymidine uptake in phytohaemagglutinin-stimulated lymphocytes during and after hip replacement performed under combined epidural- and general anaesthesia were studied using in vitro culture techniques. Monocyte-mediated cytolysis was unchanged during operation but was significantly reduced on the first postoperative day, coinciding with an increasing serum cortisol which indicates an incomplete epidural analgesia. However, there was no significant correlation between the increased cortisol concentration and the reduction of cytolysis. Lymphocyte proliferation was unchanged both during and after operation. These findings indicate that the presence of anaesthetic agents during surgery does not influence the studied functions of monocytes and lymphocytes. This supports the hypothesis that monocyte and lymphocyte depression during surgery under general anaesthesia alone is due to the trauma-induced stress reaction. The difference between postoperative suppression of monocytes and lymphocytes in this study indicates that monocytes are more vulnerable to surgical stress than lymphocytes.

Aged↗
PubMed1983

Psychotherapy for opiate addicts. Does it help?

Opiate addicts beginning a new treatment episode on a methadone maintenance program were offered random assignment to drug counseling alone or to counseling plus six months of either supportive-expressive psychotherapy or cognitive-behavioral psychotherapy. Sixty percent of patients meeting the study criteria expressed an interest and 60% of these actually became engaged. One hundred ten subjects completed the study intake procedure and kept three or more appointments within the first six weeks of the project. Measures including standardized psychological tests, independent observer ratings, and continuous records of licit and illicit drug use were done at baseline and seven-month follow-up. All three treatment groups showed significant improvement, but patients receiving the additional psychotherapies showed improvement in more areas and to a greater degree than those who received counseling alone, and with less use of medication. More than a third of opiate addicts in our treatment program thus both were interested in professional psychotherapy and apparently benefitted from it. Certain administrative procedures appear necessary to maximize the chances that psychotherapy can be used effectively with drug-addicted patients.

Adult↗
PubMed1983

The effect of epidural and general anaesthesia on lymphocyte functions during and after major orthopaedic surgery.

The blastogenic responses of lymphocytes to PHA-stimulation and lymphocyte lymphokine production have been studied in 27 patients undergoing total hip replacement, operated under either general anaesthesia or epidural anaesthesia. The lymphocytes were isolated from the patients the day before operation, during the operation and on the first postoperative day. The assays were carried out with lymphocytes cultured in medium containing 25% of the patient's serum (Au-medium) and in medium containing 25% of pooled AB+ serum (AB-medium). In the epidural anaesthesia group, the blastogenic response to PHA of lymphocytes incubated in Au-medium increased per- and postoperatively to 132% (n.s.) and 155% (P less than 0.05) compared to preoperative values. In the general anaesthesia group, the PHA-response decreased to 63.7% peroperatively (P less than 0.05) and 88.7% postoperatively (n.s.). When the lymphocytes were incubated in AB-medium, the PHA-response increased in both groups. Lymphocyte lymphokine production in the epidural group was unchanged both per- and postoperatively in both media. However, in the general anaesthesia group there was a reduction in lymphokine activity both per- and postoperatively. This reduction was most pronounced peroperatively when the lymphocytes were incubated in Au-medium (64.2%, P less than 0.05). Control lymphocytes incubated in sera from general anaesthetized patients resulted in significantly lower lymphokine activity (P less than 0.05) in comparison with cultures with sera from patients in the epidural group. These findings indicate a lymphocyte depressing factor in serum from patients operated under general anaesthesia, which is absent during operations in epidural anaesthesia.

Anesthesia, Epidural↗
PubMed1983

Psychotherapy for opiate addicts.

An opportunity to receive a six-month course of professional psychotherapy in addition to paraprofessional counseling was offered to opiate addicts who were beginning a new treatment episode on a methadone maintenance program. The treatments offered were drug counseling alone (DC), counseling plus supportive-expressive psychotherapy (SE), or counseling plus cognitive-behavioral psychotherapy (CB). Sixty percent of patients meeting the study criteria expressed an interest in the psychotherapy program and 60% of these actually became engaged. One hundred and ten subjects completed the study intake procedure, were randomly assigned to one of the three treatment conditions and kept three or more appointments within the first six weeks of the project. A variety of outcome measures showed that patients in all three treatment groups improved. Patients receiving the additional psychotherapies improved in more areas and to a greater degree than those who received counseling alone. The specific improvements seen appear to be related to the focus of the therapy used. Patients with antisocial personality disorder, as defined by Research Diagnostic Criteria, did not benefit significantly from therapy, but those with depression did. Patients with high levels of psychiatric symptoms made many significant gains if they received additional therapy, but improved only in drug use if they received counseling alone. Patients in all three treatment groups having low levels of psychiatric symptoms improved significantly in many areas. We conclude that more than a third of opiate addicts in our treatment program are interested in psychotherapy and many of these can benefit from it. Certain administrative procedures appear necessary to maximize the chances that psychotherapy can be used effectively with drug addicted patients.

Adult↗
PubMed1982

Monocyte functions are depressed during and after surgery under general anaesthesia but not under epidural anaesthesia.

Monocyte functions have been investigated in 18 patients undergoing total hip arthroplasty performed under either general anaesthesia or epidural anaesthesia. Serum cortisol increased significantly both per- and postoperatively in the general anaesthesia group compared to minor changes in the epidural group. The spreading of monocytes on plastic surfaces possibly reflects the phagocytic capacity of the cells. This spreading index of monocytes derived from patients operated under epidural anaesthesia and cultured in medium containing autologous serum showed a significant increase per- and postoperatively compared to the spreading index of monocytes from patients operated under general anaesthesia. This difference increased with increasing culture time. The ability of monocytes to induce lysis in malignant cells was reduced to 45% peroperatively in monocytes derived from patients operated under general anaesthesia and cultured in medium containing autologous serum. In the epidural group the lysis was nearly unchanged from the preoperative value, making the difference between the groups highly significant (P less than 0.01). On the first postoperative day, the difference between the groups was less pronounced. The differences in spreading index and cytolytic capacity were not seen when the monocytes were cultured in medium with pooled AB-serum, thus indicating a serum factor responsible for the monocyte depression when the patients were operated under general anaesthesia.

Aged↗
PubMed1980

Epidural versus general anaesthesia for total hip arthroplasty in elderly patients.

Sixty elderly patients were given at random either epidural analgesia with bupivacaine 0.75% or general anaesthesia with thiopentone, fentanyl, pancuronium, N2O/O2 for total hip replacement. Preoperatively the patients were of equal physical status with normal and similar laboratory values. All patients were mentally normal for their age. On the 1st postoperative day, the general anaesthesia group had a significantly lower than PaO2 than the epidural group (P less than 0.025). PaO2 in the general anaesthesia group was significantly lower than the preoperative value on the 1st and 3rd days (P less than 0.001 and P less than 0.01, respectively). None of the 29 patients in the epidural group but seven of 31 patients in the general anaesthesia group has significant mental changes postoperatively (P less than 0.01). Five of these patients still had mental changes which reduced the quality of life several months later. In the general anaesthesia group one patient died from acute myocardial infarction. Low postoperative PaO2 might have contributed to this death. Two patients in the epidural group had symptoms of pulmonary embolism postoperatively. Thus elderly patients appear to do better after hip replacement with less deterioration of cerebral and pulmonary functions when given epidural analgesia than when surgery is performed under general anaesthesia. These patients should therefore be offered epidural analgesia whenever possible.

Acid-Base Equilibrium↗