[Preparation of isomeric 1-hydroxy-7-methylquinolizidines].
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Chromatography, Gas↗
Biomedical subjects
C Karl
Publications and source records attributed to C Karl.
[Preparation of isomeric 1-methyl-1-hydroxy-7-methylquinolizidines].
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Chemistry, Pharmaceutical↗
Prophylaxis of oropharyngeal candidiasis with fluconazole.
A total of 112 cancer patients who could ultimately be evaluated were randomly assigned in a double-blind study to receive either fluconazole or placebo as antifungal prophylaxis during hospitalization. Thrush, defined by appropriate lesions in the oropharynx and confirmed by scrapings and cultures positive for Candida species, occurred in 2% of the 58 patients given fluconazole and in 28% of the 54 patients given placebo (P = .0003). Candida species were cultured from initial throat specimens from 29 patients given fluconazole and from 26 patients given placebo. Oropharyngeal candidiasis was detected subsequently in 3% of the former patients and 54% of the latter patients (P = .0001). Adverse reactions that were probably due to or aggravated by fluconazole occurred in only four patients and consisted of transient liver function abnormalities in three instances and nausea and vomiting in one. Oral fluconazole is an effective agent for prophylaxis of oropharyngeal candidiasis in susceptible cancer patients.
Adult↗
[Mortality and morbidity of premature infants weighing less than or equal to 1,000 grams: a retrospective analysis 1976 to 1987].
In a retrospective study performed at the university department of pediatrics at Aachen the development of the mortality rate of extreme low birth weight infants (less than or equal to 1000 grams) born from 1976 to 1987 has been under investigation. During this period a decline of the neonatal mortality rate from 79.5% to 29.8% could be observed. Sex, gestational age, birthweight, place of birth and delivery mode were important factors influencing the outcome of the patients. Premature babies who were born by caesarean section had a significantly higher survival rate than babies who had been delivered vaginally. Premature babies born in the university hospital at Aachen (inborns) had a remarkably lower neonatal mortality rate than infants who postpartum had been transferred to the intensive care unit from surrounding hospitals (outborns). A second aspect of this study was the development of neonatal morbidity. For some diseases like intracranial hemorrhage a decrease in frequency could be noticed. Especially high-graded intraventricular hemorrhage (IVH greater than or equal to III degrees) occurred significantly less frequent between 1985 and 1987. The comparison of morbidity rates between inborns and outborns revealed a lower incidence of hyaline membrane disease, pneumothorax and intracranial hemorrhage in inborn patients. The results of this study imply that the intensive care of extreme low birth weight infants is justified. To achieve even lower mortality and morbidity rates the importance of regionalization has to be emphasized.
Cause of Death↗
[Sampling of the chorionic villi: transcervical fine-needle and endoscopic aspiration].
In 63 cases chorionic villi sampling has been performed under complete anesthesia just before legal abortion; nine of them were endoscopic transcervical and 54 transcervical by means of a catheter under direct ultrasonic control. 81% offered useful chorionic villi, 17.4% only decidual material. The last 21 aspirations by means of a catheter between the 8th and the 12th week of gestation (p.m.) caused no problem at all. From the first punction on useful chorionic material has been obtained.
Abortion, Legal↗
[Non-invasive diagnosis of pre- and postpartum urination disorders].
Postpartal disorders of urinary discharge due to birth trauma are frequently the cause of rising infections of the urinary tract during the puerperium. In diagnosis, noninvasive methods should be preferred. Bladder-emptying function was checked by means of uroflowmetry and sonographic measurement of residual urine in 83 patients at the Department of Gynecology and Obstetrics at the RWTH, Aachen, in the third trimester and post partum. A considerable restriction of urine flow was found both prepartally as well as on the third day post partum. In contrast, there was practically no disturbance of bladder emptying on the sixth day post partum. This function is restored more quickly in cases of cesarean section than in cases of vaginal delivery. As early as the third day post partum no further influence of subpartal analgesia could be demonstrated. The findings failed to show any difference between the group with vaginal/surgical delivery and that with spontaneous birth. Generous use of these noninvasive diagnostic methods to identify postpartal micturition disorders can be recommended.
Cesarean Section↗
[Comparative studies of the venous system of the arm and leg before and after delivery].
Venous occlusion plethysmographic measurements were performed on the legs of ten non-pregnant subjects on ten consecutive days, in order to demonstrate the reproducibility of this method. In the third trimester of gestation and on the seventh day post partum, venous occlusion plethysmographic studies and vein caliber measurements were performed on arms and legs of 20 patients. A significant reduction in leg vein diameter following delivery was found. There were no differences in the diameters of arm veins measured in the third trimester and post partum. The results of venous occlusion plethysmography, as an indicator of venous function, revealed no differences between the third trimester and post partum in either the arm or the leg. Since hormonal changes during gestation must affect the entire venous system, i.e., also the arms and legs, mechanical displacement of the blood drainage pathways by the gravid uterus is most probably responsible for the significant dilatation of leg veins in the third trimester. A displacement of the higher sections of the femoral vein was demonstrated by Doppler sonography. Increased distensibility of the veins in the third trimester, continuing post partum, is probably the measurable basis of the much higher incidence of varicosis among women who have had children. It appears possible to detect extreme dilatations of leg veins sonographically, and to counter the increased risk of thrombosis and perhaps also to reduce the risk of later varicosis by timely compression treatment.
Arm↗
[Parameters of maternal oxygen transport in risk pregnancies].
Fetal oxygen supply depends on the one hand on placental perfusion and on the other on maternal and fetal oxygen transport parameters. In the study reported here the maternal oxygen transport parameters, such as the O2 half-saturation pressure P50 (mmHg) and the factors influencing it (2, 3-DPG, ATP, pH) were studied in high-risk pregnancies in comparison with a control group of normal pregnancies. A total of 112 patients at the Department of Gynecology and Obstetrics of the Rhine-Westphalian Technical University in Aachen were examined. All calculations were done with the BMDP static analysis system. Using the Mann-Whitney test, no location differences in the various parameters were detected at the level alpha = 0,05 between to group of patients with EPH gestosis and the control group. The same results were obtained when patients with placental insufficiency were compared with the control group. In contrast, a significant shift in location in oxygen transport was detectable in patients in whom there was an imminent danger of premature birth. In such cases it must be assumed that the fetus is at risk. After at least two days' intravenous administration of Fenoterol the possibility of a transient deficiency of fetal oxygen supply due to the change in the maternal oxygen transport parameters must be considered, since it cannot be assumed that there will be a compensatory increase in placental perfusion under Fenoterol. With peroral tokolysis the oxygen supply to the fetus is not impaired as far as maternal oxygen transport parameters are concerned.
Adenosine Triphosphate↗
[Changes in erythrocyte P50 and its effect on O2 transport in intravenous tocolysis with fenoterol (Partusisten)].
Fenoterol (Partusisten), which has a considerable influence on glucose metabolism in addition to its well-known cardiac side-effects, does not appear to have any direct influence on the P50 of the maternal erythrocytes in in-vitro experiments. In incubation experiments with fresh erythrocytes, fluctuations in the P50 with an amplitude of 2-5 mmHg were measured at +37 degrees C; these fluctuations depend on the storage age of the erythrocytes and the glucose content of the incubation medium. Fenoterol has no effect on the amplitude, nor on the frequency of this P50 fluctuation. The glycolytic activity of the erythrocytes, relative to the 2,3-DPG and ATP content, also remains uninfluenced under Fenoterol. The addition of progesterone or cortisone to the incubation medium has no influence on the P50 of the maternal erythrocytes. In-vivo studies of the blood of pregnant women indicate changes of the P50 with maximal "shift to the left" after 6 hours and compensatory "shift to the right" after 20 hours under tokolysis. No fluctuations of the pH value were observed in our patients. The intraerythrocytic 2,3-DPG concentration changes simultaneously with the P50. Venous pO2 increases by approx. 12 mmHg in the first 3 hours following the start of tokolysis. However, the changes in the venous pO2 are not simultaneous with the changes in the P50. It can be stated that the progesterone level has no influence on the release of O2 from the maternal blood.(ABSTRACT TRUNCATED AT 250 WORDS)
2,3-Diphosphoglycerate↗
[External cardiotocography in movement. Autocorrelation technic, an initial step for external telemetric cardiotocography?].
Ultrasonocardiograms with autocorrelation technique were registered in 60 women from 24th to 41th week of pregnancy. Registration was first done in lying position for 10 minutes, then for another 10-20 minutes in sitting position, thereafter in standing position and finally during walking around. The registration quality was good with rare gaps: median range of gaptime 1-3, 6% in the lying, 0-6% in the sitting, 0-4% in the standing and 1.8-6.4% in the walking patient. Fitting corrections of the transducer were needed nearly only when changing from lying to sitting position. In 18 parturients external ultrasonocardiography in autocorrelation technique and telemetric direct fECG-cardiography gave nearly identical registrations.
Computers↗
[Perinatal mortality and acidosis morbidity rate in pelvic presentation and vertex presentation deliveries].
Pelvic presentation deliveries in the period between 1975 and 1981 were analyzed and compared with a randomly chosen group of vertex presentation deliveries from the same period. On clarification of the group of patients delivered of pelvic presentations, the mortality rate was comparable with that resulting from vertex presentation. In both groups of patients both the mortality and acidosis morbidity rates were affected by the tendency towards premature birth. In cases of pelvic presentation, caesarian section represents the least risky method of delivery. Particularly in the event of premature birth, caesarian section should thus be given preference in all cases. Given careful individual diagnosis, mature infants -even, selectively, in the case of women giving birth for the first time--can be vaginally delivered from the pelvic presentation position.
Acidosis↗
[Para-spinal analgesia in obstetrics].
The use of regional analgesia and anesthesia in obstetrics has been established since the end of the 19th century. According to an agreement between German societies of anesthesiologists and obstetricians, regional anesthesia may be performed by both anesthesiologists and obstetricians under certain preconditions. At the RWTH Aachen hospital, the responsibility for different anesthetic techniques is divided between anesthesiologists and obstetricians in order to reduce legal risks. Caudal anesthesia is done by obstetricians, whereas anesthesiologists perform lumbar epidural anesthesia. A retrospective study over three years has shown comparable results. Lumbar epidural catheters were preferred in primiparous women, while caudal anesthesia was used more often in multiparous women. One-minute Apgar values as well as postpartum fetal arterial blood gas analyses did not differ significantly in both groups. The failure rate of caudal anesthesia was higher than that of lumbar epidural anesthesia. Blood pressure falls exceeding 20 percent of baseline were only seen in the epidural group (incidence 0.9 to 1.5 percent). The incidence of fetal bradycardia and the overall complication rate were similar in both groups.
Analgesia, Epidural↗
[Uroflowmetry and ultrasound residual urine determination in pregnancy and post partum].
In order to estimate the influence of adaptational processes during pregnancy and post partum on micturition, uroflow-parameters (3) and residual urine were examined in 119 healthy women. Comparisons were made between women in the 1st, 2nd and 3rd trimester of pregnancy, women who were between 1 and 5 days post partum and nonpregnant, fertile women. Compared with the control group the mean flow was significantly lower during the 2. and 3. trimester. Time taken to achieve maximum flow was significantly higher after spontaneous delivery compared with the control group. During pregnancy and after delivery an increase in flow time could be shown. During the 3rd trimester time taken to achieve maximum flow was noticeably higher than in the other groups. Both mean and maximum flow were lower during pregnancy and after spontaneous delivery than in the control group. Residual urine increased mainly during the 1. trimester and showed the highest value after delivery. As all the investigated differences stayed within the standardized values, uroflowmetric investigations and ultrasonic residual urine estimation during pregnancy and after delivery are only necessary if suspicious symptoms on the part of the urinary tract exist.
Adult↗