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Biomedical subjects

M Bachofen

Publications and source records attributed to M Bachofen.

At least 19 recordsLinked to original sources
PubMed2000

Self-treatment of obsessive-compulsive disorder guided by manual and computer-conducted telephone interview.

While on a waiting list for treatment by therapist-guided exposure and ritual prevention (ERP), patients with obsessive-compulsive disorder (OCD) did self-treatment at home guided by a manual plus a computer-driven telephone interview system (BT STEPS). Of 21 patients who used the system for at least three weeks while on the waiting list, one improved so much that subsequent therapist-guided ERP was unnecessary. Progress of the rest with the system predicted later progress with therapist-guided ERP. Improvement after using the system was similar to that of 20 matched historical controls who had had therapist-guided ERP without the prior use of BT STEPS. Outpatient users of BT STEPS needed less subsequent clinician-guided time than did their matched controls. In this pilot study, patients with OCD improved nearly as much with home self-treatment guided by a manual plus computer, as with treatment guided by a behaviour therapist.

Adult↗
PubMed1999

Home self-assessment and self-treatment of obsessive-compulsive disorder using a manual and a computer-conducted telephone interview: replication of a UK-US study.

BACKGROUND: This open study replicates and extends previous pilot work with BT STEPS, a self-therapy system to assess and treat obsessive-compulsive disorder (OCD) through exposure and ritual prevention. METHOD: 21 OCD patients entered this open trial, using a self-guiding manual and any Touch-Tone telephone to access computer-driven interviews via an Interactive Voice Response system. The patients also used the system to rate progress on rating scales. RESULTS: The results support those of the previous open study. Of the 21 patients, 16 (76%) completed self-assessment over a mean of 21 days. Of these, 10 patients (48%) went on to do 2 or more exposure and ritual prevention sessions over a mean of 64 days; they improved significantly on OCD symptoms, as much as is usual with serotonin reuptake inhibitor medication, and in mood and work/social adjustment. Improvement was predicted by baseline motivation and by rapid completion of self-assessment with BT STEPS, even though self-assessment alone was not therapeutic. CONCLUSION: The significant improvement in the intent-to-treat analysis was due to the subgroup of patients (48% of those who began BT STEPS) who went beyond self-assessment to do exposure and ritual prevention self-therapy at home guided by BT STEPS. A controlled trial is now needed.

Adult↗
PubMed1998

Home self-assessment of obsessive-compulsive disorder. Use of a manual and a computer-conducted telephone interview: two UK-US studies.

BACKGROUND: Two studies tested whether subjects with obsessive-compulsive disorder could successfully use BT STEPS, a computer-aided system, to perform self-assessment for self-treatment of obsessive-compulsive disorder by exposure and ritual prevention. METHOD: Subjects were given a self-guiding manual and could use a touch-tone telephone to access computer-controlled Interactive Voice Response interviews at their convenience from home. Using the BT STEPS system, patients rated themselves and worked out a plan for individually tailored self-exposure therapy. RESULTS: Outcomes were similar in the two studies. Of the 63 subjects who used BT STEPS, 84% completed the self-assessment module. Most calls were made outside usual office hours. As expected, subjects did not improve merely by completing self-assessment. However, completion of self-assessment predicted later improvement with self-exposure therapy. CONCLUSIONS: Most subjects successfully completed self-assessment using BT STEPS from their homes. DECLARATION OF INTEREST: BT STEPS is a trademark of Pfizer, Inc. I.M.M., L.B. and J.H.G. have a financial interest in BT STEPS.

Adult↗
PubMed1997

[Calcitonin, a proximal-tubular-acting diuretic: lithium clearance measurements in humans].

Lithium clearance was used to investigate the effect of calcitonin on renal sodium excretion. Two sequential renal function tests, calcitonin and placebo treated, were performed in 6 healthy students. Intravenous administration of 0.5 mg human calcitonin (hCT) (Cibacalcin, Ciba-Geigy, Basel, Switzerland) significantly raised fractional excretion of sodium (FENa), from 1.73% (0.97%) to 3.63% (0.89%) (p < 0.001), and lithium clearance (Cli), from 35.1 (5.4) to 53.9 (8.5) ml/ min x 1.73 m2 (p < 0.01). By using inulin and lithium clearance we calculated proximal (PFR), distal (DFR) and total excreted sodium (TAN). Our results clearly demonstrate that hCT has a proximal diuretic effect in humans and that a calcitonin induced proximal sodium loss is compensated by increased sodium reabsorption within 80 minutes after hCT application. Calcitonin increases the excretion of lithium and has a potential to be used in lithium intoxication.

Adult↗
PubMed1995

A randomized prospective trial of prophylactic immunosuppression with ATG-fresenius versus OKT3 after renal transplantation.

We carried out a randomized prospective trial to compare OKT3 (5 mg/d, 51 patients) with ATG-Fresenius (ATG-F, 4 mg/kg/d, 53 patients) for induction therapy after renal transplantation, concerning side effects, rejection, and infection incidence within a one year follow-up period. Concomitant immunosuppression included azathioprine/steroids from day 0 and cyclosporine A from day 4. OKT3 patients experienced significantly more and more-severe side effects, particularly pyrexia, headache, and pulmonary fluid overload. One-year graft survival was excellent in the ATG-F group (91%), but only 78% in the OKT3 group (P < 0.05) due to a series of rejections that occurred beyond day 100; patient survival (96% and 92%) was similar in both groups. OKT3-treated patients experienced more biopsy-proven rejections (0.6 +/- 0.1/pt.) than ATG-F patients (0.3 +/- 0.1, P < 0.05), and there was a similar, albeit not significant trend in clinical rejections (OKT3: 1.1 +/- 0.2/pt.; ATG-F: 0.8 +/- 0.1/pt.). Infections were more common in the OKT3 group (OKT3: 3.2 +/- 0.3, ATG-F: 2.0 +/- 0.2, P < 0.05), although this was entirely attributable to "minor" infections. On days 1 through 6, CD3 counts were more profoundly depressed with OKT3 therapy. Beyond day 10, however, CD3 counts were lower in the ATG-F group, as were CD2 counts, CD4 counts, and the CD4/CD8 ratio, suggesting a more prolonged immunosuppressive effect of ATG-F. Sensitization occurred more frequently with OKT3 (31%) than with ATG-F (10%), but was usually irrelevant, except in two patients (one in each group), whose grafts were lost because of immunization against OKT3 and ATG-F, respectively. In conclusion, a 7-day induction therapy with OKT3 does not improve outcome or diminish immunological graft loss when compared with ATG-F, but is associated with more rejections, infections, and side effects. ATG-F appears to be preferable for induction immunosuppression after renal transplantation.

Adult↗
PubMed1992

Dosage of OKT3 independent of body weight: a mistake?

Comparing OKT3 and antithymocyte globulin (ATG) in a prospective study, the dosage difference in regard to body weight (ATG: dependent on body weight/OKT3: independent) does not introduce any obvious source of mistake concerning clinical effectiveness or side effects. One explanation for the lack of influence of body weight may be the high effectiveness of 5 mg of OKT3, reaching a maximal effect even with lower plasma levels in heavier patients. We wonder, therefore, whether the OKT3 dosage could be lowered.

Animals↗
PubMed1992

Glomerular hyperfiltration after unilateral nephrectomy in living kidney donors.

Glomerular hyperfiltration, which is expected to occur after uninephrectomy, could potentially damage the non-transplanted donor kidney in living donor transplantation. We therefore prospectively measured renal function (inulin and PAH clearance), albumin excretion and blood pressure in the donors of 30 consecutive living donor kidney transplants before uninephrectomy (n = 29) and 1 week (n = 27) and 1 year (n = 16) after. Hyperfiltration was defined as: (post-nephrectomy inulin clearance)/(0.5 x pre-nephrectomy inulin clearance); hyperperfusion was defined in an analogous way for PAH clearance. Hyperfiltration averaged 128 +/- 5% [SEM] and hyperperfusion 133 +/- 6% 1 week after uninephrectomy. Hyperfiltration was nearly unchanged (126 +/- 7%) 1 year after nephrectomy, whereas hyperperfusion had significantly decreased to 118 +/- 8% (P < 0.02). There was no significant change in blood pressure after nephrectomy, and no new cases of hypertension were observed during the 1-year follow-up. The degree of hyperfiltration did not correlate with donor age. Microalbuminuria > 30 mg/24 h was found in two donors 1 week after nephrectomy (one of which normalized at 1 year) and in one additional donor 1 year after nephrectomy. The degree of hyperfiltration did not correlate with albumin excretion rate. In conclusion, no adverse consequences of hyperfiltration were demonstrable during the 1-year observation period, but the prognostic role of occasional microalbuminuria should be further investigated.

Adult↗
PubMed1991

[Prognosis following extubation in severe ARDS].

The heterogeneity of patient characteristics and the impossibility of ever including all ARDS survivors in follow-up pulmonary function studies over an extended period of time makes statements on the outcome in ARDS patients rather questionable and difficult to compare. Our conclusions are drawn from our own experience in eleven patients who survived a very serious ARDS and from recently published data. In the immediate course of ARDS all patients show restrictive ventilatory impairment and gas exchange abnormalities on exercise, often even at rest. Rarely, hypercapnic hypoxemia is seen. In the months following extubation lung function gradually improves, though sometimes this is delayed and often involves some degree of residual impairment. Pulmonary function may continue to recover for several years. A disproportionate improvement in lung volumes and gas exchanging function is not uncommon, as is the absence of clinical symptoms in the presence of residual pulmonary dysfunction. The very acute first days of ARDS onset are of little prognostic value as to incomplete repair, in contrast to the good correlation between time of mechanical ventilation or amount of oxygen needed and remaining functional deficit. There is good evidence that the recovery pattern is not influenced by the illness underlying ARDS. At present the repair mechanisms are scarcely influenced by therapeutic measures.

Adult↗
PubMed1988

Ultrastructural aspects of pulmonary edema.

The alveolar septa are designed for gas exchange as well as for the exchange of water and solutes. The organization of the tissue elements and the ultrastructural architecture of the alveolar septa minimize the interference between gas and liquid exchange even when excess water begins to accumulate in the septal interstices and the alveoli. Larger amounts of alveolar edema fluid, however, profoundly alter both function and structure of the lung parenchyma. As to the routes of abnormal fluid movement, the ultrastructural findings are not always conclusive, though in some types of permeability edema frank anatomic disruptions of the endothelial and epithelial barriers can be observed. On the other hand, in hemodynamic edema the permeability barriers appear to be intact. However, experiments involving macromolecular tracers and the presence of numerous red blood cells in the interstitial and alveolar spaces indicate that transient separations of cell junctions have taken place.

Acute Disease↗
PubMed1988

[Suppression of blood pressure increases during intubation: lidocaine or fentanyl?].

The hypertensive response to anesthetic induction with endotracheal intubation may be harmful in patients with cardiovascular disease, increased intracranial pressure, or anomalies of the cerebral vessels. Recommendations for attenuating the reflex hypertension and tachycardia elicited by upper airway irritation are therefore manifold. Besides minimizing the cardiovascular response, anesthesia induction for patients at risk must also satisfy the following requirements: it must be applicable regardless of patient collaboration, prevent impairment of cerebral blood flow, and avoid arousal of the patient; it should neither be time-consuming nor affect the duration or modality of the ensuing anesthesia. Among the recommended procedures, intravenous lidocaine or fentanyl appear to best fulfill the above mentioned criteria. However, our own equivocal observations and controversial results in the literature concerning the efficacy of intravenous lidocaine prompted us to reinvestigate the issue in two well-defined patient groups. In 46 patients with intracranial vessel malformations and 78 patients with brain tumors, blood pressure responses to endotracheal intubation were studied under anesthesia induction with 1.5 mg/kg lidocaine or 6 micrograms/kg fentanyl i.v. 30 s before thiopental injection or 2-3 min before intubation. The two equally simple induction procedures were compared to anesthesia induction with thiopental alone. In both patient groups no significant effect of lidocaine on the pressure response could be observed. Fentanyl lowered the pressure response slightly though significantly in brain-tumor patients only (p less than 0.05), but showed a significant pressure-lowering action persisting over the whole observation period in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

Cell number and cell characteristics of the normal human lung.

Eight normal human lungs obtained from patients dying from causes not related to the lung were subjected to morphometric analysis to determine the number of cells in the alveolar region and their mean volume and surface characteristics. The age range was 19 to 40 yr, average body weight was 74 kg, and the average fixed lung volume was 4,300 ml. The overall mean nuclear diameters of the nuclei of 5 major cell types in the lung parenchyma were found to have little variation, with means ranging from 7.54 to 8.77 micrometers. Alveolar type I epithelial cells were found to comprise 8% of the cells and to be one of the largest cells, having a mean volume of 1,764 micrometers 3 and covering an average of 5,098 micrometers 2 of alveolar surface. Seven percent of the alveolar surface was covered by alveolar type II cells, which make up 16% of the total alveolar cells and have a mean volume that is half that of the type I pneumocyte. Capillary endothelial cells make up 30% of the lung cells and were significantly smaller in both size and average surface area than the alveolar type I cells. Cells in the interstitial space comprised 37% of the total cells. The number of alveolar macrophages showed great variability, ranging from 19% of alveolar cells in 1 person to 3 to 5% in the nonsmoking females. The alveolar cell population characteristics found in resected lobes from 2 nonsmoking females were found to be similar to 2 nonsmoking females studied after autopsy. An interspecies comparison of characteristics of cells from the alveolar regions of normal lungs from humans, baboons, and rats showed that proportions of cells in the alveolar region and their average thickness, size, and surface areas were relatively constant.

Adult↗
PubMed1979

[Follow-up of severe adult respiratory distress syndrome].

The results are presented of the clinical, radiological and pulmonary function follow ups in 6 patients 19 to 35 months after the onset of a most severe adult respiratory distress syndrome (ARDS). The previously healthy young patients required ventilatory support for 16 to 135 days, reflecting the severity of the ARDS. In agreement with earlier studies, lung function improved rapidly in the first year but barely thereafter. Nineteen to 35 months after the ARDS a mild to moderate degree of restrictive ventilatory impairment could be detected in all our patients, associated with a significant arterial hypoxemia on exercise in five. Additionally, three patients showed signs of reversible airway obstruction. If the subacute course rather than the acute phase of the disease is taken as the criterion, there appears to be a relationship between the severity of the ARDS and the residual impairment of lung function. The fact that even most severe lung damage eventually led to a more or less significant loss of the functional reserves of the lung, but hardly ever ended in chronic respiratory failure, justifies all possible intensive care efforts in the treatment of those patients.

Adult↗
PubMed1977

[Loss of insulin during the infusion of insulin in glucose and nutrient solutions].

Controversial results of previous investigations prompted us to reassess the adsorptive loss of insulin to infusion bottles and tubings. An experimental array was chosen which was in strict accordance with the infusion technique used for the high-caloric parenteral nutrition of severely ill patients. The insulin concentrations were determined by a radioimmunoassay method. As in pure glucose solutions of various concentrations a loss of insulin amounting to about 30% was determined in high-caloric solutions containing aminoacids. The protective effect of human serum albumin, gelatine (Physiogel), and Rheomakrodex, all three of which diminish the insulin loss by about 50%, could be confirmed. The varying results obtained by different investigators may be attributable mainly to technical factors such as different surface properties of the infusion material, differences of the experimental array and analytical methods. Accordingly, variable losses of insulin may also occur in clinical practice. For daily routine an exact knowledge of these losses is irrelevant, since the insulin dosage is adjusted to the blood sugar level. However, if the insulin requirement is used as an index of the metabolic condition of the patient, precise determination of the actual loss is mandatory.

Absorption↗