Biomedical subjects

D Winter

Publications and source records attributed to D Winter.

At least 37 records · Page 2Linked to original sources

PubMed1987

NAPROS: a semiautomatic user-friendly anaesthetic record system.

NAPROS is a semiautomatic, inexpensive, and easy-to-use anaesthetic record system. It is based on an ACORN (BBC-Model B) microcomputer that is linked to a non-invasive arterial pressure monitor (DIN-AMAP 845a) and an inhalation anaesthetic monitor (Engstroem EMMA) for automatic collection of measured data. The following functions have been implemented: Automatic registration of cardiovascular data and concentration of anaesthetic inhalation agents. Graphical or numerical representation of fluid-balances. Possibility to recall dosage information for drugs and drops. Printing of a final anaesthetic report at the end of anaesthesia. Definite advantages of NAPROS are: The number of hours saved by the computer record over manual data entry is 8 hours. - Better acceptance by users.

Anesthesiology↗

PubMed1987

The significance of absent end-diastolic velocity in umbilical artery velocity waveforms.

Doppler umbilical artery velocimetry has been used to study high-risk pregnancies. The most extreme waveform abnormality is the absence of end-diastolic velocity. To examine the significance of this finding, events outcome was evaluated in 161 women studied between 31 and 36 weeks. Ten had absence of end-diastolic velocity. When compared with fetuses with normal and less severely abnormal waveforms, there was a higher incidence of intrauterine growth retardation, pregnancy-induced hypertension, cesarean section for fetal distress, neonatal intensive care unit admission, and low Apgar scores. Average birth weight and gestational age at delivery were lower. Five other fetuses with absence of end-diastolic velocity were identified that were delivered between 27 and 30 weeks, making a total of 15 patients with absence of end-diastolic velocity. Of 12 patients monitored, 11 had an abnormal fetal heart rate pattern. Four fetuses had lethal anomalies. There were eight perinatal deaths. Acute or chronic hypoxia was evident in all fetuses with absence of end-diastolic velocity. Absent end-diastolic velocity represents a unique and severe fetal condition that cannot be identified by present surveillance methods and requires a Doppler study for diagnosis.

Blood Flow Velocity↗

PubMed1987

The clinical significance of Doppler umbilical artery velocimetry in the small for gestational age fetus.

Fifty-four women who were delivered of small for gestational age infants were studied antenatally by serially continuous-wave Doppler velocimetry. Outcomes were compared in the normal and abnormal systolic/diastolic ratio groups. Seventy-eight percent had an abnormal systolic/diastolic ratio. The group with an elevated systolic/diastolic ratio had a significantly higher incidence of abnormal fetal heart rate, pregnancy-induced hypertension, oligohydramnios, cesarean section for fetal distress, and admission into the neonatal intensive care unit. One third of the newborns required intermittent positive pressure ventilation. Average birth weight and gestational age at delivery were significantly lower and there were six perinatal deaths in the group with an elevated systolic/diastolic ratio and none in the group with a normal systolic/diastolic ratio. These data suggest that the small for gestational age fetus with normal umbilical artery velocimetry is at significantly lower risk than are those with abnormal ratios. This implies that management of the small for gestational age fetus may now be aided by a functional classification based on the umbilical artery velocity waveform.

Blood Flow Velocity↗

PubMed1987

A classification of hypertension in pregnancy based on Doppler velocimetry.

We studied 136 pregnant women with hypertension with Doppler velocimetry of the uterine and umbilical arteries. The patients were classified into four groups according to the values of the systolic/diastolic ratios. The first group had normal ratios in both the umbilical and uterine arteries. The second group had elevated umbilical ratios and normal ratios in the uterine arteries. The third group had elevated uterine artery systolic/diastolic ratios with normal umbilical artery values, and the fourth group had elevated systolic/diastolic ratios in both vessels. Women in the group with normal ratios in both the umbilical and uterine arteries were delivered of infants with a birth weight (mean +/- SD) of 3261 +/- 522 gm and gestational age of 39 +/- 2 weeks. The values for the three groups with abnormal velocimetry were: those with elevated umbilical ratios and normal ratios in the uterine arteries: body weight = 2098 +/- 811 gm, gestational age = 35.7 +/- 3.2 weeks; those with elevated uterine artery ratios with normal umbilical artery values: 2464 +/- 722 gm, gestational age = 36.3 +/- 3 weeks; and those with elevated systolic/diastolic ratios in both vessels: body weight = 1627 +/- 697 gm, gestational age = 33.3 +/- 2.7 weeks (p less than 0.01; p less than 0.001). There were 27 small for gestational age infants delivered during this study. Doppler velocimetry studies were abnormal in 26 of them (96%). Results show that Doppler-derived vascular patterns correlate well with normal and adverse perinatal outcome. A description of the uterine and umbilical systolic/diastolic ratios should be part of the clinical evaluation of all pregnant women with hypertension. This should lead to better treatment protocols and improved clinical outcome.

Adult↗

PubMed1987

Uterine artery Doppler velocimetry: the significance of divergent systolic/diastolic ratios.

Continuous wave Doppler studies were carried out on both uterine arteries in 71 pregnant women from the twentieth week of gestation onward. Analysis of the waveform included the systolic/diastolic ratio and the presence or absence of a diastolic notch. In the current study, these ratios from 31 women with left/right systolic/diastolic difference, (between left and right uterine arteries) were compared with those of women having normal ratios. A normal left/right systolic/diastolic ratio difference of 0.3 with SD of 0.3 was found. When the left/right difference was plotted against the left/right averaged systolic/diastolic ratio, a correlation coefficient of 0.7 was noted (p less than 0.001). Significant outcome differences were noted between normal and abnormal left/right difference systolic/diastolic ratios in the perinatal parameters of gestational age at delivery, fetal weight, pregnancy-induced hypertension, proteinuria, and intrauterine growth retardation. Divergent uterine artery ratio findings are a result of one artery being the dominant supplier to the placenta. The majority of women with an elevated systolic/diastolic ratio seem to have divergent uterine blood supply to the uterus and placenta. These data suggest that errors in placentation site contribute to the development of preeclampsia and growth retardation in the fetus.

Arteries↗

PubMed1987

Diagnostic utility of hepatobiliary scintigraphy with 99mTc-DISIDA in neonatal cholestasis.

We retrospectively evaluated the utility of hepatobiliary scintigraphy and various clinical factors in differentiating intrahepatic cholestasis from biliary atresia in 28 consecutive infants with neonatal cholestasis. One millicurie of technetium-labeled diisopropyliminodiacetic acid (DISIDA) was administered intravenously, and images were obtained for up to 24 hours or until gastrointestinal excretion was noted. Nine separate studies in seven infants with biliary atresia were correctly interpreted as showing no gastrointestinal excretion of radionuclide. Of the 21 patients with intrahepatic cholestasis, only nine had gastrointestinal excretion on the first study; in eight without excretion, a second study was done, and five of these showed gut excretion. All infants with either neonatal hepatitis (six) or inspissated bile syndrome (three) had demonstrable gastrointestinal excretion either on the first or second DISIDA study. However, five of six infants with paucity of intrahepatic bile ducts, two of six infants with cholestasis secondary to total parenteral nutrition, and one infant with cholangiolitis did not show evidence of gastrointestinal excretion. The mean birth weight, mean gestational age, and mean weight at study were significantly greater (P less than 0.005) for infants with biliary atresia without excretion than for infants with intrahepatic cholestasis without excretion. The mean direct bilirubin concentration was 6.0 mg/dL for both infants with biliary atresia and infants with intrahepatic cholestasis without excretion; however, infants with excretion had a significantly lower (P less than 0.02) mean direct bilirubin value of 3.4 mg/dL. Excretion was noted in four infants with total bilirubin values greater than 10.0 mg/dL. The absence of gut excretion on the first DISIDA study was 100% sensitive but only 43% specific for biliary atresia. In infants without gut excretion of DISIDA, birth weight greater than 2200 g was 100% sensitive and 92% specific for biliary atresia. We conclude that DISIDA scanning, together with clinical data, is useful in differentiating extrahepatic from intrahepatic cholestasis. The absence of gut excretion on the first DISIDA study does not necessarily indicate extrahepatic obstruction; the study should be repeated if the diagnosis is not clear.

Bile Ducts, Intrahepatic↗

PubMed1987

Construction and constriction in agoraphobia.

A formulation of agoraphobia is presented in personal construct theory terms. It is hypothesized that the construing of agoraphobics and their spouses is characterized by low cognitive awareness of constructs concerning interpersonal conflict and lack of tenderness; by dilemmas in which the ability to go out implies possible infidelity; and by low self-esteem in the agoraphobic and high self-esteem in their spouse. Evidence in support of these hypotheses is provided by a repertory grid study comparing agoraphobics, non-agoraphobic neurotics, spouses of both client groups, and normal subjects. Features of construing of agoraphobic and spouse are shown to be predictive of the agoraphobic's response to behaviour therapy, and therapeutic improvement to be associated with some reconstruction in the above areas. The role of mutual validation of constructions between agoraphobic and spouse in the maintenance of agoraphobic behaviour is discussed, as are implications for the treatment of agoraphobia.

Adult↗

PubMed1986

Renal failure does not impair the metabolism of morphine.

The pharmacokinetics of morphine were measured using gas chromatography-mass spectrometry (GCMS) with specific ion monitoring after the intramuscular administration of papaveretum to four patients with renal failure (one anephric) and three normals. The apparent t1/2 of absorption and t1/2 of elimination were significantly shorter in the patients with renal failure (P less than 0.05). Morphine glucuronides are eliminated slowly in these patients as expected. Renal failure does not impair the elimination of morphine.

Adult↗

PubMed1986

[NAPROS--a semiautomatic, user-friendly anesthesia protocol system].

NAPROS is a semiautomatic inexpensive and easy to use anaesthetic record system. It is based on an ACORN (BBC-Model B) micro-computer that is linked to an non-invasive arterial pressure monitor (DINAMAP 845a) and an inhalation narcotic monitor (Engstroem EMMA) for automatic collection of the measured data. The following functions have been implemented: automatic registration of cardiovascular data and concentration of narcotic inhalation agents; input of drugs, fluid input or fluid output, laboratory values, events and comments of the anaesthetist; collection of administrative data and data concerning the preoperative state of the patient; graphic or numeric representation of fluid-balances; survey of all or selected drugs that have been administered up to that time; possibility for recalling dosage information for drugs and infusions; parallel printing of all collected data as a preliminary anaesthetic record; printing of a final anaesthetic report at the end of anaesthesia.

Anesthesiology↗

PubMed1985

Dimensional change of acrylic resin tray materials.

Twelve commonly used acrylic resin tray materials were compared for linear curing shrinkage. Three of the 12 were found to expand slightly during the first few hours, which had the effect of reducing the net shrinkage. All trays, however, exhibited shrinkage during the 24-hour test period. Therefore, autopolymerizing acrylic resin tray materials should not be used for an impression the same day that they are made unless the tray is boiled as suggested by Pagniano et al. This agrees with research already completed even though the magnitude of shrinkage was considerably less than that reported in previous studies.

Acrylic Resins↗

PubMed1984

[The anesthesia protocol].

It has long been recognised that it is necessary to document all medical actions. Every anaesthesia is to be documented on an anaesthetic transcript. Such a transcript has various purposes. It serves principally as an adequate patient-support, but also has administrative, statistical, scientific and forensic purposes. The transcript used at the Mannheim Klinikum is a printed form, which, apart from recording intra-operative events, also has room for entering pre- and post-operative test results. The recording of an anaesthetic transcript is an essential part of the duties of the anaesthetist in the clinic. Today, with the application of the most differentiated administrations of narcosis, it would seem that we can no longer do without a properly made anaesthetic transcript.

Anesthesia↗

PubMed1973