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Biomedical subjects

G Blümel

Publications and source records attributed to G Blümel.

At least 19 recordsLinked to original sources
PubMed1992

[Blood coagulation and fibrinolysis in prostate surgery].

In 23 patients undergoing transurethral resection of the prostate (n = 11) or suprapubic prostatectomy (n = 12), hemostasis and fibrinolysis were studied. In addition to basic coagulation tests, antithrombin III, plasminogen, antiplasmin and fibrin degradation products were determined preoperatively, intra-operatively and postoperatively over a period of 6 days. Evaluation of the results revealed slightly activated blood coagulation and fibrinolysis intraoperatively and postoperatively, with no significant differences being seen between the two groups. Routine use of antifibrinolytic drugs in patients undergoing surgery of the prostate is not recommended.

Aged↗
PubMed1991

[Light and scanning electron microscopy studies of the pleura. A contribution to the pathogenesis of spontaneous pneumothorax in young patients].

In a prospective study of 10 patients (7 men, 3 women, mean age 26.2 years), who underwent thoracotomy because of recurrent spontaneous pneumothorax, we performed light and scanning electron microscopic investigations of the resected pleura. The purpose of our work was to explain pleural changes which allowed the penetration of air through the intact wall of the blebs. In 8 of 10 cases we found small bullae at the top of the upper lobe, the remaining 2 showed up with massive pleural scar. The morphological and ultrastructural findings indicated that the presence of air induced a reactive process at the visceral pleura which led to degeneration and scarification. The changes consisted of simple membrane formation up to complete destruction of the pleural layer. The development of blebs is due to an air fistula coming out of the lung parenchyma. Penetration of air through the bleb's wall is explained with the increasing pressure inside and the dehiscence of degenerated pleural structure. In our opinion spontaneous pneumothorax in young people is caused by a localized disease of the upper lobe. The pleural changes are the visible effects of a degenerative process induced by air fistula from lung parenchyma. Therefore wedge-resection of that region is a rational therapy in patients with spontaneous pneumothorax.

Adult↗
PubMed1991

Coagulation in aortofemoral bifurcation bypass grafting.

Few data are available on the pathophysiology of the coagulation system during aortic surgery. Cross-clamping of the aorta, intestinal eventeration and circulatory shock in ruptured aortic aneurysms are thought to cause coagulation disturbances and hyperfibrinolysis. A prospective study of several parameters of the clotting system, i.e. standard clotting tests, platelet count, indicators of fibrinolysis, inhibitors of the clotting cascade and proteases were measured perioperatively in aortobifemoral bypass grafts. Ten patients undergoing elective procedures and two emergency cases with ruptured aortic aneurysms were included. The standard clotting tests reflected the use of heparin. A similar course of ATIII, C1-inhibitor, alpha 2-antiplasmin, plasminogen and fibrinogen with a decrease during the operation and a return to almost normal values postoperatively, were due to intra-operative blood loss, haemodilution and a slight activation of the clotting cascade, as well as, hyperfibrinolysis. This observation was supported by the increased levels of euglobulin lysis and PMN-elastase and the resultant increase in some fibrinogen degradation products, indicating non-specific proteolysis. These changes were more pronounced in the two emergency cases, except for the heparin induced changes in PTT and thrombin time. It is concluded that non-specific proteolysis may be an important factor in the pathogenesis of clotting disorders in surgery of the aorta. Further research is needed to discover the pathways of non-specific proteolysis and its prevention by protease inhibitors.

Aorta, Abdominal↗
PubMed1991

Study of a dose-dependent effect of the glycosaminoglycan polysulfate on various parameters of blood coagulation.

In a double-blind study the dose-dependent effect of 10, 20, 40, and 70 mg of SSHA was tested in volunteers. Whereas only a minor prolongation of the aPTT was noted, a clear anti-factor Xa effect was proven (method of Yin), as well as the release of lipoprotein lipase. In a subsequent study, 12 volunteers were treated daily with a dose of 40 mg for 11 days. On the first day of treatment a dosage of 40 mg SC was administered three times every 90 min. There was no cumulative effect with this dose and a clear plateau effect was recorded daily after each application. Repeated administration therefore results in an identical reproducible effect. Thus, no tachyphylaxis occurred under long-term treatment with 40 mg SSHA.

Adult↗
PubMed1990

[Special aspects of abdominal adhesions in gynecology].

Even minor adhesions in the oviduct or in the ovarial region may lead to infertility. In a controlled trial the adhesion status was documented in 103 patients who underwent microsurgical operations for infertility. Solutions of (a) streptokinase/streptodornase, (b) hydrocortisone acetate or (c) Ringer's solution only were administered intraperitoneally as adhesion prophylaxis. During a control laparoscopy 1 week after the primary operation, newly formed adhesions of mainly intermediate extent were observed in about 10% of the patients. There was no significant difference in efficacy between the prophylactic treatment.

Combined Modality Therapy↗
PubMed1990

[Prevention of adhesions in abdominal surgery. A dose finding study with streptokinase/streptodornase].

UNLABELLED: Measurement of intraperitoneal fibrinolytic activity on 50 patients having undergone abdominal surgery (four of them controls). Instillation of streptokinase/streptodornase (Varidase) into the abdominal cavity. Determination of total protein, plasminogen, antiplasmin, alpha 2 Mx-plasmin-complex, spontaneous fibrinolysis and fibrinolysis + activator at different points in time p.op. RESULTS: Intraperitoneal fibrinolysis may be stimulated by local substitution of a plasminogen activator (Varidase). Systemic effects are confined to a high dose. No impaired wound healing nor increased propensity to hemorrhaging occurred.

Abdomen↗
PubMed1990

[Combination anesthesia in sheep with ketamine-(fentanyl)-guaifenesin (My 301)-laughing gas-halothane].

The concept of combined anaesthesia, the centrally-acting muscle relaxant guaifenesin (My 301) in a 5% solution with ketamine (and/or fentanyl) in addition to the inhalation of nitrous oxide and halothane is based upon the principle of "balanced anaesthesia". Guaifenesin amplifies the effect of several anaesthetics, which complement one another, allowing the dosage to be decreased and thereby reducing the cardiovascular stress. To induce anaesthesia, the combination of a cataleptic anaesthetic (ketamine = Ketanest, Ketolar) and a centrally acting skeletal muscle relaxant (guaifenesin = Myolaxin, My 301) is used. Because of the risk of aspiration the animal should be intubated as soon as possible. Anaesthesia will be prolonged by the carrier gas nitrous oxide (65%, weakly analgesic)/oxygen (65%), low concentrations of halothane (1.0 to 0.6 to 0.4%, weakly hypnotic and analgesic) and by a continuous drip infusion of 5% guaifenesin (relaxing, mild analgesic and sedative). The effect of all the other anaesthetics is increased by guaifenesin. To increase the analgesia and to control the cardiovascular parameters the additional injection of ketamine or fentanyl is recommended. The recovery period is short and the general condition is good both after a lengthy anaesthesia of 9 hours (n = 32) and after anaesthesia of 2 hours. No significant adverse effects on the cardiovascular system were detected.

Anesthesia↗
PubMed1990

[Bone healing--an immunoreactive process?].

Cell mediated immune reactions, demonstrated by leukocyte migration assay and histological analysis of spleen and lymph nodes, could be observed after fresh autografting of cortical segments in rats. The detected immune answer showed a bone-specific reaction pattern. In consideration of the temporal correlation of the observed immune reactions and the histological signs of graft incorporation, a connection of bone healing and immune system may be possible.

Animals↗
PubMed1990

[Orotracheal intubation in rats].

A detailed description of the technique of orotracheal intubation under visual control in rats is given. This method was used successfully in 190 animals, the complication rate being 3.2%. The hazards consisted of laryngospasm (1.6%) and fatal bleeding (0.5%). Intubation was proved to be a safe, reliable, simple and atraumatic way to establish a patent airway in this laboratory animal.

Animals↗
PubMed1989

[Pulse oximetry--a non-invasive method for direct and continuous monitoring of oxygen saturation and pulse rate--comparative studies with blood gas analysis and hemoreflectometry in the dog, swine and sheep].

The use of pulse oximeters as a non-invasive, real time and online method for the continuous monitoring of oxygen saturation is discussed and compared to other methods like hemoreflectometry, and blood gas analysis. Analyses of linear regression show extraordinarily good correlations between all three monitoring systems. Pulse oximetry and hemoreflectometry on the one hand and blood gas analysis on the other hand sometimes show quite differing values of oxygen saturation. This phenomenon is due to the fact that the measuring methods are based on different working principles as well as it can be explained by the various hemoglobin-types. The pulse rate also measured by the pulse oximeter is nearly completely identical to the heart rate of the ECG. A slight temporal delay between the two acoustic signals is noticed and justified. Pulse oximetry seems to be superior to other oxygen monitoring systems because of its continuous noninvasive measuring technique.

Animals↗
PubMed1989

Cortisol deficiency in metomidate anesthetized bacteremic pigs: results in circulatory failure--beneficial effect of cortisol substitution.

Etomidate and the closely related metomidate are known to inhibit cortisol synthesis. We studied the influence of metomidate on hemodynamic performance and survival time of bacteremic pigs. Thirty pigs, 30.2 +/- 0.8 kg, were anesthetized with intravenous metomidate (2.5 mg.kg-1.h-1) plus ketamine (3.0 mg.kg-1.h-1), and were then mechanically ventilated. The animals were randomly allocated to three groups of 10 pigs each. Group A received an infusion of live Pseudomonas aeruginosa bacteria (2.5.10(9).kg-1.h-1 organisms until death), Group B additionally received a bolus of 1 mg.kg-1 cortisol (followed by an infusion of 0.1 mg.kg-1.h-1) starting 1 h prior to the bacterial infusion, and Group C served as anesthesia control without receiving bacteria or cortisol. The experiments in Group C were terminated after 10 h. In Group A the cortisol level was severely suppressed from the very beginning. The animals died of circulatory failure after 4.3 +/- 0.4 h. In contrast, Group B exhibited fairly stable hemodynamics, but the animals died due to pulmonary edema after 11.1 +/- 1.3 h. Cortisol deficiency in metomidate anesthetized pigs facilitates the development of circulatory failure in the course of Pseudomonas bacteremia, which does not occur if cortisol is infused to reconstitute a physiological level. However, this cortisol substitution did not prevent the development of pulmonary edema caused by Pseudomonas aeruginosa. Possible mechanisms of the deleterious effect of cortisol deficiency and implications in regard to the clinical use of metomidate/etomidate are discussed.

Anesthesia, Intravenous↗
PubMed1989

Indications for combined high frequency ventilation in clinical use.

A retrospective study of 20 surgical intensive care unit patients is reported. They were ventilated with continuous positive pressure ventilation (CPPV) and then switched to combined high frequency ventilation (CHFV). To find why there were variable responses to CHFV, the data of 20 patients were retrospectively evaluated with respect to respiratory index (RI), compliance (C) and extravascular lung water (EVLW). The results suggest that the indication line for CHFV was a C value greater than 45 ml/cmH2O and an EVLW value greater than 15 ml/kg BW.

Adult↗