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Biomedical subjects

B Holtmann

Publications and source records attributed to B Holtmann.

At least 37 records · Page 2Linked to original sources
PubMed1994

Use of ketorolac after lower abdominal surgery. Effect on analgesic requirement and surgical outcome.

BACKGROUND: Ketorolac is a nonsteroidal antiinflammatory agent with opioid-sparing properties. The effect of ketorolac on postoperative opioid analgesic requirement and surgical outcome was evaluated in 198 women after abdominal hysterectomy procedures using a double-blind protocol design. METHODS: Patients were randomly assigned to receive either 60 mg intravenous (2 ml) ketorolac, followed by 30 mg intravenously (in saline 20 ml) over 30 min every 6 h, or 2 ml intravenous saline, followed by saline 20 ml intravenously over 30 min every 6 h, for up to 72 h. The postoperative opioid analgesic requirement was assessed using a patient-controlled analgesia (PCA) device to self administer either morphine or meperidine. The authors also evaluated pain, sedation (or drowsiness), fatigue, quality of sleep, and postoperative side effects at 2-8-h intervals for up to 72 h after surgery. RESULTS: Ketorolac decreased the PCA opioid usage on the night of operation and during the first postoperative day. Ketorolac also improved the quality of sleep during the first night after surgery. Although ketorolac- (vs. saline-) treated patients had a significantly shorter time to passage of bowel gas (50 +/- 24 h vs. 61 +/- 25 h), there were no clinically significant differences in the times to oral intake, unassisted ambulation, or hospital discharge. There were also no differences in the overall incidence of side effects in the ketorolac- (vs. saline-) treated patients. However, the use of ketorolac with opioid PCA was associated with a reduced need for antiemetic therapy on the postsurgical ward. CONCLUSIONS: The authors conclude that the opioid-sparing effects of ketorolac contributed few clinically significant advantages after abdominal hysterectomy procedures.

Adult↗
PubMed1993

Disruption of the CNTF gene results in motor neuron degeneration.

CNTF is a cytosolic molecule expressed postnatally in myelinating Schwann cells and in a subpopulation of astrocytes. Although CNTF administration prevents lesion-mediated and genetically determined motor neuron degeneration, its physiological function remained elusive. Here it is reported that abolition of CNTF gene expression by homologous recombination results in a progressive atrophy and loss of motor neurons in adult mice, which is functionally reflected by a small but significant reduction in muscle strength.

Aging↗
PubMed1992

Effects of a nighttime opioid infusion with PCA therapy on patient comfort and analgesic requirements after abdominal hysterectomy.

Since pain during the early postoperative period can disrupt a patient's normal sleep pattern, we investigated the influence of a nighttime "basal" infusion of morphine on patient comfort, ability to sleep at night, restfulness, and analgesic requirements following elective abdominal hysterectomy. One hundred fifty-six adult women were randomly assigned to receive either patient-controlled analgesia (PCA) alone or PCA supplemented with a nighttime infusion of morphine 1.0 mg.h-1. The infusion was started in the postanesthesia care unit and continued until the morning after surgery. Subsequently, the infusion was used only during the nighttime hours (10 PM-8 AM). Patients in both treatment groups were able to self-administer supplemental bolus doses of morphine, 2 mg intravenously, as needed during the 72-h study period. The use of a nighttime morphine infusion did not significantly improve the patient's ability to sleep or to rest comfortably at night. Only 8% and 7% of patients in the control and infusion groups, respectively, found it inconvenient to self-administer bolus doses at night. In addition, the number of patient demands and supplemental bolus doses, opioid usage, and recovery parameters were similar in the two treatment groups. The use of a basal infusion resulted in six programming errors, and three patients required discontinuation of the infusion because of hemoglobin oxygen desaturation (i.e., SpO2 less than 85% for greater than 5 min). We concluded that the routine use of a continuous nighttime opioid infusion in combination with a standard PCA regimen failed to improve the management of postoperative pain, sleep patterns, or recovery profiles compared to PCA alone after abdominal hysterectomy.

Adult↗
PubMed1991

Patient-controlled analgesia. Does a concurrent opioid infusion improve pain management after surgery?

OBJECTIVE: --To assess the influence of a continuous (basal) morphine infusion as part of a patient-controlled analgesia (PCA) system on the postoperative analgesic requirement and on recovery parameters following abdominal hysterectomy. DESIGN: --Single-center, randomized, controlled protocol. SETTING: --University medical center. PARTICIPANTS: --A total of 230 adult women were randomly assigned to receive no morphine infusion (control group) or a continuous 0.5-, 1.0-, or 2.0-mg/h morphine infusion. Each patient was able to self-administer supplemental intravenous bolus doses of morphine (1 to 2 mg) using a PCA infuser. MAIN OUTCOME MEASURES: --Use of the PCA device, opioid-related side effects, recovery times, and the patients' assessment of pain and sedation on linear visual analog scales were recorded during the 72-hour study period. Follow-up questionnaires were completed by the patients and their health care professionals to assess the overall adequacy of PCA therapy. RESULTS: --Patients who received the 2-mg/h morphine infusions received significantly more opioid medication 9 to 72 hours after their operation than those who received no infusion (control group). The presence of a continuous morphine infusion of 0.5 to 2 mg/h did not significantly decrease the number of patient demands or supplemental bolus doses administered compared with the control group. Overall, 168 (84%) of the 199 patients who completed the 72-hour study were able to achieve adequate analgesia without requiring changes in the PCA regimen or experiencing major side effects. Recovery times and outcome variables were similar in all four groups. CONCLUSION: --The routine use of a continuous opioid infusion in combination with a standard PCA regimen does not improve pain management compared with PCA alone after abdominal hysterectomy.

Adult↗
PubMed1991

Fulminant hepatic failure after repeated exposure to isoflurane anesthesia: a case report.

A previously healthy but obese 26-yr-old woman was diagnosed as having hepatic dysfunction 17 days after the third of three consecutive exposures to isoflurane anesthesia for paranasal sinus surgery. Serum laboratory findings included elevated aminotransferases and bilirubin. Radiographical evaluations showed no evidence of extrahepatic disease. Serological studies were negative for acute viral infections, and serum copper was normal. The patient's condition deteriorated over the ensuing 17 days, with hyperreflexia, hypoglycemia and a rapid fall in serum aminotransferases with a concomitant rise in bilirubin level and prothrombin time despite maximal medical support. The liver volume as shown by computed tomography fell from 1,290 cm3 to 680 cm3 over 6 days. The patient underwent successful orthotopic liver transplantation 25 days after onset of symptoms. Histopathological examination of the resected liver showed submassive and massive necrosis, with a few foci of microvesicular steatosis and ultrastructural evidence of mitochondrial abnormalities. Although we found insufficient evidence to prove that this case was caused by isoflurane anesthesia, the clinical course and histopathological findings are similar to those in hepatic injury caused by halothane anesthesia. Therefore we report this as a possible case of fulminant hepatic failure resulting from isoflurane anesthesia.

Adult↗
PubMed1989

Selective shunting during carotid endarterectomy based on two-channel computerized electroencephalographic/compressed spectral array analysis.

The reliability of selective shunting based on computerized electroencephalographic (EEG) monitoring has not been addressed. In this study, 103 carotid endarterectomies were performed with selective shunting based on a two-channel computerized EEG monitor that processed the on-line, raw electroencephalogram (EEG) to produce a compressed spectral array (CSA). Ischemic EEG events were identified by amplitude attenuation of the raw EEG and/or loss of high-frequency activity on the CSA. Fourteen patients (13.6%) received a bypass shunt, and postoperative neurological examinations showed 97 patients (94.2%) to be intact. A correlation between total (cumulative) ischemic EEG time and the postoperative neurological exam was demonstrated (P less than 0.0001). Six postoperative deficits (5.8%) occurred, five in patients whose computerized EEGs demonstrated an ischemic EEG event late during carotid clamping, when it was no longer possible to place a shunt. The sixth deficit was found in a patient whose EEG did not demonstrate any patient whose EEG did not demonstrate any signs of cerebral ischemia. Five of these six new deficits resolved within 12 hours, and only one persisted for 72 hours, when the patient died of a pulmonary embolism (cerebral infarction and mortality rate of 1%). These results appear to demonstrate that two-channel monitoring of both the CSA and the unprocessed (raw) EEG simultaneously can be used as a reliable indicator of whether a bypass shunt is required during carotid cross-clamping in all patients, regardless of their preoperative neurological history or angiographic findings.

Brain Damage, Chronic↗
PubMed1984

A comparison of three techniques of palatorrhaphy: early speech results.

Sixty-two patients with cleft lip and palate or cleft palate were randomly assigned an operative technique for primary palatorrhaphy: V-Y pushback, Langenbeck, or Langenbeck with pharyngeal flap. Early speech results were evaluated in 52 patients. There were no differences among the treatment groups in late complications, hearing, middle ear disease, velopharyngeal competence, or need for speech therapy, speech bulbs, or secondary pharyngeal flaps. As previously reported, the in-hospital morbidity in these patients was greater with V-Y pushback (more blood transfusions) and Langenbeck plus pharyngeal flap (more upper airway obstruction) palatorrhaphies than with the Langenbeck procedure. The addition of a pharyngeal flap to primary palatorrhaphy seems unnecessary in at least 75% of patients. Therefore, we currently recommend the Langenbeck palatorrhaphy for primary cleft palate repair, although further longitudinal studies of these patients are needed to assess later speech results and maxillary growth.

Cleft Lip↗
PubMed1983

A randomized comparison of triangular and rotation-advancement unilateral cleft lip repairs.

We prospectively and randomly compared triangular and rotation-advancement unilateral cleft lip repairs in 35 patients. The most significant difference between the two repairs noted in this series was a greater frequency of hypertrophic scars following rotation-advancement repairs. The overall appearance of the lip and nose postoperatively was the same in both groups.

Child↗
PubMed1983

Severe epistaxis in facial fractures.

The incidence of epistaxis in 312 patients with facial fractures over a 5-year period is reviewed, finding the incidence of epistaxis to be 4 percent in all facial fractures and 11 percent (12 of 108) in midface fractures. Six of these required treatment with packing or transfusion, and two required surgery to control the epistaxis. The only other series reviewing epistaxis in facial fractures reported a similar incidence.

Adult↗
PubMed1982

Decreased collagenase production by regional fibroblasts cultured from skin of a patient with connective tissue nevi of the collagen type.

A 10-yr-old female presented with cerebriform tumors covering the plantar surfaces of both feet. Histologically, the lesions consisted of thick collagen fibers and the content of collagen per surface area of skin was increased about 8-fold. Examination of the collagen by SDS-polyacrylamide gel electrophoresis, after limited pepsin proteolysis, showed that the lesions consisted almost exclusively of type I collagen, the predominant collagen type in human skin. Thus, a diagnosis of connective tissue nevi of the collagen type was made. Fibroblast cultures were established from the affected and normal-appearing areas of the skin, and examined for the rate of collagen synthesis, production of collagenase and growth kinetics of the cells. Cell cultures derived from the lesion and from control skin synthesized procollagen at the same rate and in a normal type I/type III procollagen ratio. However, the production of enzymatically active and immunologically detectable collagenase was reduced by 70-82% in the cultures derived from the lesion as compared to controls (p less than 0.005). Fibroblasts derived from the lesions also displayed a mean population doubling time of 1.17 +/- 0.08 days compared to 1.83 +/- 0.24 and 1.92 +/- 0.09 days for control cell strains and cells derived from normal skin of the patient, respectively (p less than 0.025). These results suggest that the excessive deposition of collagen in this case may have resulted from decreased local degradation of collagen. Enhanced proliferative capacity of the regional fibroblasts may have contributed to the accumulation of collagen in these lesions.

Cells, Cultured↗
PubMed1982

Peripheral nerve entrapment syndromes in chronic hemodialysis patients.

15 of 271 patients (6%) treated with chronic hemodialysis developed peripheral nerve entrapment syndrome of the median or the ulnar nerve. The majority of these patients were female (p less than 0.03). Fistulas located in arms with nerve entrapment tended to have higher flow rates than fistulas located in arms without nerve entrapment (57%) vs. 4.4%, p less than 0.001). There was no correlation with the renal diagnosis, previous access surgery in the involved arm, the type of vascular access used, the duration of hemodialysis, the adequacy of dialysis, calcium or phosphate homeostasis, plasma parathyroid levels, or thyroid function. Surgical intervention successfully relieved all symptoms. Return of normal renal function dose not reverse this disorder. Peripheral nerve entrapment is a common surgically correctable cause of neuropathy of the upper extremities in hemodialysis patients.

Adolescent↗
PubMed1981

A randomized comparison of four incisions for orbital fractures.

We previously compared conjunctival and subciliary incisions for exposure of orbital floor and infraorbital rim fractures. A prospective randomized comparison of lower eyelid and orbital rim incisions was then undertaken and results compared with our previous study. Lower eyelid and orbital rim incisions provided more rapid access to fracture sites. Fracture exposure was adequate with all but conjunctival incisions; lateral canthotomy was added in 56 percent of cases to improve exposure. There were minimal or no intraoperative and postoperative complications except for a 42 percent incidence of ectropion following subciliary incisions. Scar appearance was similar in the four groups, except when an isolated conjunctival incision was used, which produced an invisible scar.

Adolescent↗
PubMed1981

The association of submucous cleft palate and clefting of the primary palate.

478 records of patients with cleft palate were reviewed to determine the prevalence and significance of submucous cleft palate associated with clefting of the primary palate. The prevalence of submucous cleft palate in the 71 patients with clefts of the primary palate (SMCP-CL) was 13 per cent. This is two to three times greater than the prevalence of isolated submucous cleft palate found in cleft palate clinic patients. Patients with SMCP-CL often had the symptoms of velopharyngeal incompetence (VPI) and middle ear disease. The increased prevalence of SMCP and frequent symptomatology of patients with clefting of the primary palate make it essential that patients with cleft lip have early, thorough evaluation for SMCP. Early detection of SMCP associated with cleft lip and close follow-up permits the prevention of ear problems and the proper management of VPI should it develop.

Child, Preschool↗
PubMed1980

Trigger finger and thumb, secondary to amyloidosis.

We present a case in which infiltration of the flexor tendons and the fibrous sheaths of the digital flexors with amyloid caused triggering at both the entrance to the fibrous sheaths and at the decussation of the sublimis tendons.

Amyloidosis↗
PubMed1979

Congenital lip pits and Hirschsprung's disease.

A newborn infant with aganglionosis of the entire colon and terminal ileum also had congenital lip pits and a submucous cleft palate. These anomalies may be added to the growing list of conditions associated with Hirschsprung's disease.

Adult↗
PubMed1979

A comparison of three technics of palatorrhaphy: in-hospital morbidity.

We report the first randomized prospective comparison of different techniques of palatorrhaphy. The in-hospital morbidity of the Wardill-Kilner repair (Group I), von Langenbeck repair (Group II), and von Langenbeck repair with superiorly based pharyngeal flap (Group III) was evaluated in 47 patients. There were no deaths. Transfusion was needed only in Group I patients (p less than 0.01). Postoperative airway obstruction was significantly more common in Group III patients than in Group I (0 per cent or II (6 per cent) (p less than 0.05). Thus the in-hospital morbidity was least following the von Langenbeck repair.

Airway Obstruction↗
PubMed1977

Carpal tunnel syndrome following vascular shunts for hemodialysis.

Carpal tunnel syndrome developed in the hands of two patients five to six months after Quinton-Scribner vascular shunts for hemodialysis were removed from the forearm of the symptomatic upper extremity. Thickened flexor tendon synovium within the carpal tunnel in al three cases suggests that the cause is an increase in the volume of the contents within the rigid confines of the carpal canal. Division of the transverse carpal ligament and synovectomy resulted in complete relief of symptoms 4, 14, and 23 months after operation. Carpal tunnel syndrome should be considered an additional new complication of vascular shunt procedures in patients treated by hemodialysis for renal failure.

Adolescent↗