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Biomedical subjects

E Kramer

Publications and source records attributed to E Kramer.

At least 37 records · Page 2Linked to original sources
PubMed1989

Importance of heterosexual activity in the transmission of hepatitis B and non-A, non-B hepatitis.

To identify previously unrecognized sources for acquiring acute hepatitis B and non-A, non-B (NANB) hepatitis, we interviewed patients with these types of hepatitis who were reported to two county health departments in the United States and matched control subjects for known and potential risk factors for acquiring hepatitis. Of 218 patients with hepatitis B and 140 patients with NANB hepatitis, 46% and 53%, respectively, had no commonly recognized source for infection. When these patients were compared with control subjects, significantly more patients with hepatitis B had multiple heterosexual partners, accounting for 14% of all hepatitis B infections; more patients with NANB hepatitis either had sexual or household contact with a person who had hepatitis in the past or had multiple heterosexual partners, accounting for 11% of all NANB infections. This is the first study to suggest that heterosexual transmission may play an important role in the spread of NANB hepatitis.

Adult↗
PubMed1988

[Personal preparation of bicarbonate solutions--cost comparison and quality control].

Haemodialysis with bicarbonate dialysate is well established in the treatment of chronic renal failure. The costs of bicarbonate haemodialysis are higher than acetate haemodialysis. Commercially available bicarbonate solutions are sold from AS 129.- to AS 189.- per 8 litre canister (December 1987). The self-prepared solution contains 650 g bicarbonate (for AS 8.-) in 8 litres of deionized water. In 10 patients on regular dialysis treatment haemodialysis were performed with both commercially available and self-prepared solutions for a 3 week period. Blood and dialysate samples were obtained before and 10 minutes, 1 h, 2 h, 3 h and 4 h after starting haemodialysis. Osmolality, Na+, K+, Cl-, pO2, pCO2 and pH were measured in the dialysate and in the serum, as well as serum lactate levels. There were no significant differences and the biochemical changes were similar with both preparations. In our centre with about 4000 bicarbonate dialyses yearly, AS 500,000.- to AS 700,000.- could be saved by self preparation of the dialysate.

Bicarbonates↗
PubMed1988

Protective effect of the bispiperazinedione ICRF-187 against doxorubicin-induced cardiac toxicity in women with advanced breast cancer.

Studies in animals suggest that the bispiperazinedione ICRF-187 can prevent the development of dose-related doxorubicin-induced cardiac toxicity. In a randomized trial in 92 women with advanced breast cancer, we compared treatment with fluorouracil, doxorubicin, and cyclophosphamide (FDC), given every 21 days, with the same regimen preceded by administration of ICRF-187 (FDC + ICRF-187). Patients were withdrawn from the study when cardiac toxicity developed or the cancer progressed. The mean cumulative dose of doxorubicin tolerated by patients withdrawn from study was 397.2 mg per square meter of body-surface area in the FDC group and 466.3 mg in the FDC + ICRF-187 group (no significant difference). Eleven patients on the FDC + ICRF-187 arm received cumulative doxorubicin doses above 600 mg per square meter, whereas one receiving FDC was able to remain in the study beyond this dose. Antitumor response rates were similar (FDC vs. FDC + ICRF-187, 3 vs. 4 complete responses; 17 vs. 17 partial responses; and 9.3 vs. 10.3 months to disease progression). Although myelosuppression was slightly greater in the FDC + ICRF-187 group, the incidence of fever, infections, alopecia, nausea and vomiting, or death due to toxicity did not differ between the groups. Cardiac toxicity was evaluated by clinical examination, determination of the left ventricular ejection fraction by multigated nuclear scans, and endomyocardial biopsy. In comparisons of the FDC group with the FDC + ICRF-187 group, clinical congestive heart failure was observed in 11 as compared with 2 patients; the mean decrease in the left ventricular ejection fraction was 7 vs. 1 percent when the cumulative dose of doxorubicin was 250 to 399 mg per square meter (P = 0.02), 16 vs. 1 percent at 400 to 499 mg (P = 0.001), and 16 vs. 3 percent at 500 to 599 mg (P = 0.003); and the Billingham biopsy score was 2 or more in 5 of 13 patients undergoing biopsy vs. none of 13 (P = 0.03). We conclude that ICRF-187 offers significant protection against cardiac toxicity caused by doxorubicin, without affecting the antitumor effect of doxorubicin or the incidence of noncardiac toxic reactions.

Adult↗
PubMed1988

The role of computed tomography in evaluation of skeletal metastases.

Computed tomography was performed in 100 patients for additional evaluation of suspected skeletal metastases following radionuclide bone scanning in 86 patients and conventional radiography in all. A retrospective review of these cases revealed that the majority (78%) involved the spine and pelvis. Computed tomography contributed to the diagnosis of a malignancy by revealing a definite destructive lesion of bone in 27 patients who had an abnormal radionuclide bone scan, a normal or inconclusive radiograph, or both. It excluded a malignant lesion in 19 patients. In 38 patients, computed tomography provided additional information that contributed to such aspects of patient care as obtaining tissue diagnosis, determining the extent of lesions, and evaluating the response to treatment. False diagnoses were made in two patients. Detection by computed tomography of a skeletal lesion and histologic documentation, frequently by computed tomography-guided percutaneous needle aspiration biopsy, greatly curtailed an otherwise extensive search for the primary site. Furthermore, this information altered the treatment plan by obviating the need for radical resection or biopsy of the primary tumor and by directing the choice of an appropriate chemotherapeutic regimen.

Adult↗
PubMed1988

Organismic variables and pain inhibition: roles of gender and aging.

Multiple pain-inhibitory systems dependent upon both opioid and nonopioid mechanisms of action have been identified, particularly in the rodent. The experimental subject has typically been the young, adult male rat, and generalizations concerning these systems have been made from this subject pool. This review focuses upon the roles of two organismic factors, aging and gender, in the modulation of analgesic processes. Using an array of age cohorts (4, 9, 14, 19, 24 months), these data illustrate that aging produces differential decrements in the analgesic responses following morphine, different parameters of footshock, continuous cold-water swims (CCWS: a nonopioid stressor), intermittent cold-water swims (ICWS: an opioid stressor) and 2-deoxy-D-glucose (a mixed opioid/nonopioid stressor). In contrast, neither beta-endorphin nor food deprivation analgesia is affected by aging. This review identifies that CCWS and ICWS analgesia are sensitive to gender differences, gonadectomy differences and steroid replacement differences such that females display less analgesia than males, gonadectomy reduces both analgesic responses, and that testosterone is most effective in reinstating gonadectomy-induced analgesic deficits. These data are considered in terms of therapeutic implications for the organismic variables under study as well as for the conceptual and methodological modifications that must be made in studying intrinsic pain inhibition.

Aging↗
PubMed1986

Age-related decrements in the analgesic response to cold-water swims.

Among the compromised physiological responses affected by aging is an impaired ability to thermoregulate in a cold environment. Since acute exposure to cold-water swims (CWS) produces both analgesic and hypothermic responses in young adult rats, the present study examined whether systematic variations in these responses occurred as a function of age. Separate cohorts of 4, 9, 14, 19 and 24-month old female rats received a no-swim condition and a 2 degrees C swim for 3.5 min with tail-flick latencies, jump thresholds and core body temperature assessed 30, 60 and 90 min later. The order of conditions was counterbalanced with an interval of four days between conditions. While the four younger cohorts displayed similar CWS analgesia on the tail-flick test, the 24-month cohort failed to display CWS analgesia on this measure. Age-related differences in CWS analgesia on the jump test appeared more gradual with the three older cohorts displaying significant attenuations relative to the 9-month group, and the oldest cohort displaying significant attenuations relative to the 4-month group. In contrast, the hypothermic effect of CWS was significantly potentiated in the three oldest cohorts, with a progressive inability to cope with thermoregulation observed as a function of age. The observed decrements in the analgesic response to CWS as a function of age appear to represent a change in (a) the ability of the animal to perceive the CWS stimulus as stressful (b) an endogenous pain-inhibitory system and/or (c) an endogenous pain transmission system that is independent of thermoregulatory mechanisms.

Adrenalectomy↗
PubMed1986

Effects of muscarinic receptor antagonism upon two forms of stress-induced analgesia.

The present study assessed in rats the effects of muscarinic receptor antagonism upon analgesia induced by cold-water swims (CWS: 2 degrees C for 3.5 min) and 2-deoxy-D-glucose (2DG: 600 mg/kg). First, CWS analgesia was significantly reduced 30 min after the swim by scopolamine (0.01 and 0.1 mg/kg) and methylscopolamine (10 mg/kg) pretreatment, and was eliminated 60 min after the swim by scopolamine (0.01-10 mg/kg) and methylscopolamine (1,10 mg/kg) pretreatment. In contrast, scopolamine potentiated CWS hypothermia. Second, while scopolamine (1 mg/kg) and methylscopolamine (1,10 mg/kg) pretreatment prolonged 2DG analgesia, both antagonists dose-dependently reduced 2DG hyperphagia. Third, the changes in analgesic and hypothermic stress responses were not due to baseline shifts in jump thresholds or body temperatures. However the dose-dependent reductions by scopolamine and methylscopolamine in baseline food intake and 2DG hyperphagia were significantly correlated. Fourth, the dose-dependent reduction by scopolamine and methylscopolamine of pilocarpine analgesia differed in pattern from the other analgesic effects, suggesting heterogeneity in muscarinic receptor modulation of different analgesic responses.

Acetylcholine↗
PubMed1985

Age-related decrements in the analgesic and hyperphagic responses to 2-deoxy-D-glucose.

Among the compromised physiological responses affected by aging is an impaired response to glucose. Since administration of 2-deoxy-D-glucose (2DG) produces both analgesic and hyperphagic responses in young adult rats, the present study examined whether systematic variations in these responses occurred as a function of age. Separate cohorts of 4, 9, 14, 19 and 24 month old female rats received ascending doses of 2DG (0, 50, 250, 450, 650 mg/kg) with tail-flick latencies and jump thresholds assessed 30, 60 and 120 min later. Then the same rats received 2DG injections (0, 650, 1200 mg/kg) and food intake was assessed 5 hr later. Significant decreases in 2DG analgesia were observed on the tail-flick test as a function of age with the maximal decrease observed at the highest 2DG dose. Significant decreases in 2DG analgesia were generally observed on the jump test as a function of age, although this effect was not as robust as that observed on the tail-flick test. Finally, significant and systematic decreases in 2DG hyperphagia were observed as a function of age following both the 650 mg/kg and the 1200 mg/kg doses. The observed decrements in the analgesic and hyperphagic responses to 2DG as a function of age appear to represent an orderly alteration in responses to glucoprivation through adulthood.

Aging↗
PubMed1985

The value of the radionuclide angiogram in the prediction of perioperative myocardial infarction in patients undergoing lower extremity revascularization procedures.

To better define the group of patients at high risk of myocardial infarction (MI) and death associated with lower extremity revascularization procedures, resting gated blood pool studies were obtained in 100 such patients before surgery and results were correlated with the prevalence of perioperative MI. The results indicated that three patient groups could be distinguished on the basis of cardiac ejection fraction. Group I (n = 50) had preoperative ejection fractions ranging from 56% to 83%. None of the patients in group I suffered an acute perioperative MI. Group II (n = 42) comprised patients with ejection fractions ranging from 36% to 55%. There was a 19.0% prevalence of MI in group II, with one cardiac death. Group III included eight patients with ejection fractions ranging from 26% to 35%. There was a 75% prevalence of perioperative MI in these patients, with one cardiac death. All perioperative MIs occurred within the first 48 hr after surgery. Statistical analysis demonstrated a significantly higher prevalence of perioperative MI in patients with gated pool ejection fractions of 35% or less compared with the prevalence in patients with one or more of the other widely used clinical signs of increased cardiac operative risk (p less than .02).

Aged↗
PubMed1984

The value of radionuclide angiography as a predictor of perioperative myocardial infarction in patients undergoing abdominal aortic aneurysm resection.

To define the group of patients at high risk for myocardial infarction (MI) and death associated with abdominal aortic aneurysm repair, resting gated blood pool studies were obtained on 50 such aneurysm patients preoperatively. The results indicated that three groups could be distinguished among these patients by cardiac ejection fraction. Group I (n = 25) had preoperative ejection fractions ranging from 56% to 85%. None of the patients in group I suffered an acute perioperative MI. Group II (n = 20) comprised patients with ejection fractions ranging from 36% to 55%. There was a 20% incidence of MI in group II but no cardiac deaths. Group III included five patients with ejection fractions ranging from 27% to 35%. There was an 80% incidence of perioperative MI in these patients, with one cardiac death and one cardiac arrest. All perioperative MIs occurred within the first 48 hours after surgery. In addition there was a 50% incidence of perioperative MI among all those patients who were 80 years of age or older. These results indicate guidelines for the management of patients undergoing abdominal aortic aneurysm repair based on their preoperative ejection fraction. The data further suggest that the noninvasive gated blood pool method of determining ejection fraction may serve a more broadly useful function in helping to determine which of those patients about to undergo major surgical procedures are at high risk for perioperative MI.

Aged↗
PubMed1984

Pressure sore management: efficacy of a moisture reactive occlusive dressing.

Twenty-five pressure sores occurring in a total of 21 patients were evaluated for their response to an adhesive hydrocolloid occlusive dressing (HCD). All ulcers had been treated previously. Response to the occlusive dressing was compared with previous clinical response. Due to the discharge or transfer of patients, evaluation of HCD therapy was usually made after a relatively short period of treatment, average treatment length being 27 +/- 3 days. Fourteen of the 25 decubitus ulcers (56%) demonstrated marked improvement or complete healing with HCD therapy. In contrast, only two of the 25 ulcers (8%) had demonstrated marked improvement under previous treatment. Of 16 ulcers which had failed to improve previously, seven (44%) had either healed or showed marked improvement with the use of the occlusive dressing. For ulcers which had healed, average healing time with HCD was 37 +/- 7 days.

Adolescent↗
PubMed1983

Dissociation of analgesic and hyperphagic responses following 2-deoxy-D-glucose.

Injection of 2-deoxy-D-glucose (2DG) elicits both analgesic and hyperphagic responses in rats. While pituitary dysfunction, decreased dopamine availability, or neonatal monosodium glutamate treatment decreases 2DG hyperphagia, they increase 2DG analgesia. In contrast, 2-DG analgesia alone is decreased by repeated 2-DG injections, while 2-DG hyperphagia alone is decreased following naloxone pretreatment. The present four experiments examined further mechanisms subserving these two induced responses. In the first experiment, rats were deprived of food for 6 h following 2-DG (600 mg/kg). While 2-DG hyperphagia persisted in the absence of glucoprivation, 2-DG analgesia failed to occur after this delay. In the second experiment, acute exposure to inescapable foot shock (4 mA, 0.5 s/5 s for 1 h) preceded administration of 2-DG (600 mg/kg). While 2-DG hyperphagia was eliminated by this procedure, 2-DG analgesia was significantly potentiated. In the third experiment, repeated morphine (10 mg/kg) injections over 14 days eliminated 2-DG analgesia on the fifteenth day, but failed to affect 2-DG hyperphagia. In the fourth experiment, lesions placed in either the lateral hypothalamus or zona incerta decreased 2-DG hyperphagia, but failed to affect 2-DG analgesia. These results are discussed in terms of common and dissociative mechanisms mediating both responses.

Analgesics↗