Biomedical subjects
Publications and source records attributed to K Erdmann.
Intraocular pressure decreased by 22.6% in association with neuromuscular blockade produced by vecuronium 0.1 mg kg-1. This appeared to be the result of an indirect action possibly via an effect on CVP. Vecuronium would be a suitable neuromuscular blocker for patients undergoing eye surgery in whom an increase in IOP would be undesirable.
The effect of Trendelenburg position (5 degrees head-down) for 60 or 45 s on the spread of hyperbaric 0.5% tetracaine and 0.5% bupivacaine (3 or 4 ml) was studied in 80 patients scheduled for urological surgery. The mean spread of analgesia was faster (p less than 0.05) and greater (p less than 0.05) in patients tilted head-down for 45 s receiving 4 ml tetracaine than in those with 3 ml tetracaine and 60 s Trendelenburg position. With bupivacaine corresponding results of both volumes, 3 or 4 ml, were similar. Tetracaine compared with bupivacaine showed a faster cephalad spread with 4 ml (p less than 0.05) but not with 3 ml. The onset time of motor blockade in all groups was short (less than 10 min) and complete (Bromage III). The results prove that 4 ml of 0.5% tetracaine with 5% Trendelenburg position for 45 s ensure a rapid and safe spread of analgesia with adequate motor blockade for transurethral surgery.
The activities of enteropeptidase, alanine aminopeptidase, sucrase, and leucine aminopeptidase were determined in mucosa biopsies taken from three defined places of the duodenum and in duodenal juice. We examined 23 adults with a histological proven normal mucosa and 10 patients suffering from duodenitis grade I. Using multivariate evaluation of all the four enzyme activities of the three mucosa sites, we could differentiate duodenitis from normal mucosa with an efficiency of 88%.
The factors underlying the unpredictability of the pharmacokinetics of rectally administered methohexitone remain unclear. The "pH partition hypothesis" offers an explanation. We investigated six children with rectal pH values ranging from 7.5 to 9.8, who were given 25 mg/kg methohexitone 10% via the rectal route under general anaesthesia. Blood samples were taken at zero, 3, 5, 7, 10, 15, 20, 30, 40, 60, 90 and 120 min; rectal pH was measured at zero and 1 min. The methohexitone plasma levels reached a maximum (Cmax) of 2.63 micrograms/ml (median) after 17.5 min (median). The elimination half-life ranged from 37 to 218 min. No positive correlation between lower pH and better resorption (AUC and Cmax) was found. The resorption kinetics of rectally administered methohexitone cannot be explained by its electrochemical properties alone.
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Ketamine 25 mg/kg was administered to five foxhounds by the intravenous, intramuscular or rectal route. Plasma concentrations were measured by gas-chromatography and analgesia was tested by two techniques. Intravenous application gave reliable analgesia and well reproducible plasma levels in all subjects. Distribution and elimination half lives were found to be 6 min and 55 min, respectively. Intramuscular injection resulted in peak-plasma levels around the twentieth minute, elimination half life was fifty-two minutes, bioavailability 90%. Analgesia proved satisfactory in four out of the five subjects and lasted longer than after intravenous injection. The rectal route produced a wide range of peak-plasma levels, the average peak appearing after 40 min. We found an elimination halflife of 43 min and a bioavailability of 30%. Analgesia was poor in four out of the five subjects. The low plasma levels following rectal application are due to the poor bioavailability and this appears to be the reason for the unsatisfactory results with this route of administration. Bioavailability depends on the site of application (drainage mainly through the vena cava or portal vein) and the pH of the rectum.
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In 104 patients with longstanding abdominal pain of unknown origin endoscopic pancreatography was carried through after a thorough noninvasive exploration (Secretin-CCK-test included). Pancreatography revealed in 18% slight but distinct-pathological changes at the pancreatic duct system compatible with chronic pancreatitis. As the frequency of the pathological pancreatographic findings showed no correlation with duration of pain history but a significant correlation with age it is suggested that the duct changes encountered represent rather age-dependent irrelevant fibrosis of the pancreas tan clinically relevant chronic pancreatitis. Slight pathological duct changes are by themselves no proof of chronic pancreatitis because there is no possibility to discriminate between chronic pancreatitis and age-dependent fibrosis on the ground of pancreatography. ERP therefore is of little or no value in patients with otherwise insubstantial suspicion of chronic pancreatitis.
Immunostaging was performed in patients with chronic pancreatitis of different etiologic groups. Immune responifveness was assessed by immunoglobulin serum levels, non specific autoantibody formation, C3 levels, antistreptolysin reaction, antibody titer against Toxoplasma gondii, E. coli, Herpes simplex-, Mumps- and Cytomegalovirus and screening for soluble immune-complexes (PEG precipitation assay), number of T- and B-lymphocytes, lymphocyte responsiveness to PHA, PPD, tetatoxoid and mumps-antigen in a whole blood assay, skin testing with candidin, trichophytin, tuberculin and streptokinase and HLA-typing. In some cases we found a depressed cell-mediated immune responsiveness. Patients were divided into two groups based on this main finding. Cellular hyporesponsiveness was correlated to the severity of the disease and a high incidence of HLA-B5 but not to any etiologic factor of the disease.
The better to comprehend isobaric spinal anaesthesia, we constructed a thermoregulated model of the subarachnoid space. With it we investigated the six not exactly isobaric local anaesthetics bupivacaine, carticaine, lidocaine, mepivacaine, prilocaine and tetracaine, in order to determine the effect of the following factors on their spread: injected volume, position, density, temperature of the injected solution, rate of injection, barbotage, direction of the spinal needle and its opening. The injected volume was most important. The small differences in density were of consequence in the vertically mounted model. Higher rates of injection increased the spread. The remaining factors were not relevant. The investigation corroborates the clinical observation that spinal anaesthesia with approximately isobaric solutions is a well controllable technique.
The authors have performed successively endoscopic retrograde pancreatography (ERP) and secretin-pancreozymin test (SPT) 104 times. A good correlation between ERP und SPT was demonstrated in 84.6%: 50% of patients with pathologic pancreatogram showed also an abnormal pancreatic function test while 36 (34.6%) out of 104 examinations demonstrated both normlal ERP und SPT. A discrepancy between both procedures was found only in 15.4%: pathologic ERP and normal SPT (9.6%) and reversal (5.8%). In conclusions, ERP and pancreatic function tests appear complementary to each other in the evaluation of pancreatic disorders.
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The deep duodenoscopy serves for the endoscopico-bioptic clarification of radiologically unclear findings distally from the bulb (niches, sockets, stenoses) and of the positional relations between diverticulum and papilla. As a rule, it is connected with an endoscopic retrograde cholangiopancreaticography (ERCP). The endoscopic retrograde pancreaticography is indicated in relapsing chronic pancreatitis for proving or excluding of changes needing operation which are taken into consideration as partial factors of the relapsing course as well as in suspicion to a local pancreatitis complication and carcinoma of the pancreas. The endoscopic retrograde cholangiography is a decisive aid for the differentiation of the cholostatic icterus. It improves the diagnostics of complaints after operative interventions at the system of the biliary ducts, facilitates the diagnosis of the papillary stenosis and is indicated in insufficient conventional contrasting the biliary ducts. The complications (pancreatitis, cholangitis, cystic infection) have become rare with increasing experience. Contraindications are the florid pancreatitis and cholangitis.
In ENT surgery due to the differential anatomy of the operation area, radical tumour surgery, necessary plastic surgery and covering of resulting defects, plus efforts in maintenance and reconstruction of important functions the resulting operations are frequently lengthy. In 27 patients whose operations required longer as 10 hours the problems of anaesthesia and operation were analysed and discussion from various angles. With close teamwork between surgeon and anaestheist in the planning and carrying out of such procedures and in the postoperative care it is possible to eliminate higher risks due to the prolonged operation time. The perioperative mortality rate within a time period of 4 weeks was in our case 0%.
The influence of halothane and enflurane on the nuclear metabolism of bronchial mucosa cells was investigated over ten hours on 5 dogs each anaesthetized with halothane or enflurane. Desoxyribonucleinic acid (DNS) and, for the arginine and lysine-rich histone fraction the basic amino-acids arginine and lysine were measured. During the ten hours of anesthesia there was a decrease of all patterns, reversible in a control 48 hours after the end of anesthesia. The decrease of DNS and arginine was similar to each other, but that of lysine was delayed. The results indicate a reversible retardation of the nuclear metabolism. The site of action is probably in the activated zone of nucleus.
The densities of cerebrospinal fluid and of local anesthetics, applicable to isobaric spinal anesthesia, were determined by using the Digital Density Meter DMA 02. The density of CSF showed little variation and at 37 degrees C was 1.00021 +/- 0.00024 g/cm3 (mean +/- SD, n = 22). The density of the local anesthetics bupivacaine 0.5%, carticaine 2%, lidocaine 2%, mepivacaine 2% and prilocaine 2% varied at 25 degrees C between 1.001 and 1.005 g/cm3, at 37 degrees C between 0.997 and 1.001 g/cm3. Tetracaine 0.5% in CBF increased its density by 0.00046 g/cm3. The addition of the vasoconstrictors adrenaline and ornipressine (POR 8) increased the density of the local anesthetic solutions insignificantly. On the basis of the narrow range of variation of CSF density, reliable statements may be made on the density dependent spread of local anesthetics in spinal anesthesia.
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