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Biomedical subjects

K H Wollinsky

Publications and source records attributed to K H Wollinsky.

33 records · Page 2Linked to original sources
PubMed1991

Liquorpheresis eliminates blocking factors from cerebrospinal fluid in polyradiculoneuritis (Guillain-Barré syndrome).

Cerebrospinal fluid (CSF) derived from six patients with polyradiculoneuritis (Guillain-Barré syndrome, GBS) treated by liquorpheresis was injected into rat sciatic nerve. By measuring spinal evoked potentials after stimulation of the tibial nerve, we observed slowing or dispersion of nerve conduction in those cases where the CSF had been taken before liquorpheresis. CSF of the same patient, sampled after liquorpheresis, showed minor effects only. Impairment of nerve conduction was seen between 5 and 20 min after injection, normal function being restored on the third day. These results suggest that liquorpheresis eliminates blocking factors from the CSF of patients with GBS. We postulate this as the effect by which liquorpheresis improves neurological symptoms in Guillain-Barré syndrome.

Animals↗
PubMed1991

Liquorpheresis (CSF-filtration): an effective treatment in acute and chronic severe autoimmune polyradiculoneuritis (Guillain-Barré syndrome).

In recent years, plasmapheresis has become a well established treatment of acute and chronic polyradiculoneuritis (Guillain-Barré syndrome, GBS). Nevertheless, there are still non-responders and there are particular risks associated with this treatment. Despite all efforts, the duration of severe forms of Guillain-Barré syndrome is still considerable. Inflammation and demyelination start intrathecally. We therefore used liquorpheresis (cerebrospinal fluid filtration) as a new effective therapeutic approach. Our first patient, severely disabled with acute GBS, artificially ventilated, had undergone plasma exchange without effect. Plasma immunoadsorption led only to transient improvement. After several liquorphereses, the patient recovered completely. In three additional patients with acute and two with chronic GBS an improvement of clinical signs in close temporal relation to liquorpheresis was observed. Twice, liquorpheresis was combined with immunoadsorption of cerebrospinal fluid. Liquorpheresis was well tolerated in all cases. This procedure may be effective by eliminating humoral or cell-bound factors responsible for the onset or/and maintenance of inflammation. Further controlled studies are necessary and are in progress.

Acute Disease↗
PubMed1991

[Experiences with autologous donation and transfusion equipment].

For autologous plasma predeposit there are commonly two types of cell-separators in use: 1. Discontinuous centrifugation (Plasma Collection System PCS, Haemonetics Company). 2. Discontinuous membrane filtration (Plasmapur-Monitor, Organon Teknika Company). Normally donation volume is 900 ml. The rate of undesired secondary effects does not exceed those numbers known of regular homologous donors. Shed wound blood processing by a wash-centrifuge cell separator (Type Cell-Saver, Haemonetics Company) stands for optimal quality of the refusable red blood cells. Depending on the type of operation and the accuracy of wound blood suction, up to 75% of the red blood cells lost may be harvested. In order to achieve more widespread mechanical autotransfusion, one issue is to lower the rather high costs of the disposables by simplifying the too highly sophisticated systems. From clinical experience with orthopedic patients, at least practical advice is given on how to use the single autologous transfusion methods in a comprehensive strategy.

Blood Component Removal↗
PubMed1991

[Kinetics of bacterial wash-out in the Haemonetics Cell Saver III].

Autologous, outdated blood units were inoculated with four types of bacteria--Pseudomonas aeruginosa, Escherichia coli, Streptococcus faecalis, Staphylococcus aureus--in two concentrations (10e4, 10e6) to test the effect of the washing procedure (Cell Saver III Haemonetics) on the elimination of bacteria. The elimination rate ranged from 17% (Streptococcus faec. 10e4) to 96% (Pseudomonas aer. 10e6). These results confirm the routine use of wash centrifuge systems (type Cell Saver) to process shed wound blood as well as drainage blood for autologous transfusions.

Blood↗
PubMed1991

Less drug fever with intrathecally applied interferon-beta (short communication).

Systemic therapy of encephalitis with human interferon-beta regularly causes fever up to more than 41 degrees C. Patients often developed hematological changes, nausea and tachycardia. Analyzing the temperature curves of 13 patients with repeated intrathecal, lumbar instillations of 1.0 x 10(6) IU natural IFN-beta, we found markedly less drug-associated fever. Mean temperature was maximal at 38.7 degrees C 12 h after instillation; individual temperature did not exceed 39.7 degrees C, and was elevated for less than 36 h. Day-time of application did not change these results. After the first IFN-beta instillations, the mean integral of temperature vs time was twice as high as after subsequent applications. One and a half days after intrathecal administration and from 39 degrees C on, fever is independent from lumbar IFN-beta. Lower dosage, a more than ten-fold reduction of costs and less interference led us to prefer intrathecal interferon-beta applications. Given the data presented, we cannot yet evaluate clinical efficacy of intrathecal IFN-beta.

Adolescent↗
PubMed1990

[Differentiated blood replacement therapy in endoprosthesis surgery of the hip joint].

In a prospective clinical study with 37 patients (41-84 years) undergoing a first implantation of hip joint endoprothesis, a total blood loss of two liters in average was registrated including the first 24 h postoperative wound drainage blood. Sufficient volume replacement was achieved without any homologous blood components by consequently using a comprehensive concept of autologous transfusion including acute preoperative hemodilution, intra and postoperative blood salvage and preoperative plasma predeposit (ATU = Autologous Transfusion-Concept of Ulm). Plasma and blood substitution was managed mainly by polygelin and autologous fresh frozen plasma completed by autologous warm blood and processed autologous washed packed red cells. Through this any organization troubles or disadvantages of whole blood predeposit may be avoided. To increase the net gain of washed packed red cells time limited use of blood salvage disposables should be extended.

Adult↗
PubMed1990

[4 years experience with the Ulm autologous transfusion concept].

After a 4-year period in clinical practice the autologous transfusion concept Ulm (ATU) has proved its value. The effort and expense involved are entirely justified by obvious medical advantages. The patients' active involvement in the therapeutic procedure is a remarkable aspect of positive motivation. Furthermore, the medical staff is positively motivated, too, in spite of the obvious additional load to their daily routine work.

Blood Transfusion, Autologous↗
PubMed1988

[Preoperative plasmapheresis].

Plasmapheresis is performed during the preoperative patient preparation phase of the Ulm Autologous Transfusion Concept (ATU). On an outpatient basis, weeks or months before the operation, 900 ml autologous plasma is donated per visit using the one needle technique, shock frozen, and stored at -30 degrees C or lower. During a period of approximately 1 1/4 years, 813 patients were studied in order to obtain information (in addition to the observation of the usual vital statistics) concerning the effect of plasmapheresis on homeostasis and coagulation factors directly before, directly after, 2 h after, and 24 h after (in-patients only). A complete electrolyte solution of the Ringer-lactate type was used as volume substitution (1000 ml or 1500 ml). Arterial blood pressure and heart rate showed no significant change. The transient decrease in various laboratory parameters was within tolerable limits. The parameters for blood protein, anti-thrombin III, and immunoglobulin G had already normalized within 24 h. Our more than three year experience with more than 2600 patients and the collective data indicate no reason not to perform plasmapheresis on non-fasting outpatient patients. The for the most part postoperatively transfused autologous fresh frozen plasma represents an ideal, long acting volume substitution which contains such blood components as antithrombin III, immunoglobulins, and factor XIII. These blood components could be a contributing factor for a decreased danger of thrombosis, embolie, and infection, as well as provide for better wound healing.

Blood Coagulation Tests↗
PubMed1984

[Comparative studies on the side effects of morphine after peridural, spinal and intravenous administration].

A prospective randomized study was carried out on 29 patients undergoing transurethral prostatectomy. In addition to the regional anaesthetic given for the operation, the patients received either: 1 mg morphine intrathecally (spinal group), 0.05 mg/kg body weight of morphine i.v. (i.v. group), or 0.05 mg/kg body weight epidurally (PDA group). Two of the intrathecal group patients had to be given an antagonist because of clinically relevant respiratory depression. In one of these cases, this depression could be documented by a continuous fall in respiratory minute volume, and an increase in PCO2. In the other, bradypnoea and vomiting developed within a few minutes of injection. The presence of a central action of intrathecal and epidural opiates was indicated by the significant increase in reaction time found. In the two instances of respiratory depression, the CSF morphine concentration 24 hrs after injection was markedly lower (0 and 18 ng/ml respectively) than in unaffected patients. It must therefore be assumed that the respiratory depression was caused by a more rapid cephelad transport than that occurring in normal cases.

Aged↗
PubMed1984

[The effect of intraoperative PEEP ventilation and postoperative CPAP breathing on postoperative lung function following upper abdominal surgery].

The problem of how to improve postoperative pulmonary function after upper abdominal surgery was investigated in a randomized study involving 64 patients who were subjected to various treatment regimens designed to increase airway pressure. Intraoperative ventilation was carried out with either zero or positive end exspiratory pressure, and postoperatively either CPAP or a nasal oxygen catheter were applied. The following groups were formed: 1. ZEEP /O2-catheter; 2. PEEP/O2-catheter; 3. ZEEP /CPAP; 4. PEEP/CPAP. The typical reduction in vital capacity occurred postoperatively, the lowest value being recorded on the 2nd postoperative day, an alteration in respiratory pattern with reduced tidal volume and increased respiratory rate together with an initially low, later normal alveolar ventilation, and an initial hypoxaemia which was at first associated with a moderate hypercapnia, on the second postoperative day with a normocapnia, were observed. At no point in time could a difference be found between the 4 groups, no measurable improvement in respiratory function being found as a result of the treatment given. Intra- and post-operative increase in airway pressure was however found to be associated with a reduction in the incidence of post-operative pulmonary complications.

Abdomen↗
PubMed1984

[The traumatic emergency patient in emergency service. Critical evaluation of 718 emergency cases].

The emergency service activities of 718 traumatic cases during a two years period are critically analyzed: Reanimations in traumatic patients are rare (3.8%) and have a bad outcome. Regarding stabilization of vital functions, intravenous infusion is the most frequent kind of treatment (ca. 75%). Compared to other studies endotracheal intubation and ventilation are rather often carried out (greater than 17%). Catheterization of the vena cava is rarely used (less than 3%), coniotomia of the trachea never performed. The emergency doctor's first diagnosis was verified in 97%. In the remainder he was wrong, however, this being of no grave consequence. First aid treatment was adequate in 87% but incomplete in 13%. Nevertheless, incompleteness of treatment did not caused any patient's death.

Adolescent↗
PubMed1983

[Peridural morphine analgesia: effects and pharmacokinetics. A double-blind study in vaginal hysterectomy patients].

In a controlled prospective double-blind-study we were able to show that the analgesic duration of epidurally applied morphine is more than four fold longer lasting than intravenous morphine. We found similar pharmacokinetics in both groups, suggesting a rapid absorption of epidurally applied morphine into the vascular system. The identical pharmacokinetics of intravenous and epidurally applied morphine suggest that only small amounts of morphine diffuse across the dura to the spinal cord, where it produces a long lasting analgesia at the opiate receptors. The comparison of serum morphine levels in patients who reported a very short lasting and very long lasting analgesia gave us no pharmacokinetic explanation for this difference.

Adult↗