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Biomedical subjects

M Friedemann

Publications and source records attributed to M Friedemann.

At least 19 recordsLinked to original sources

[The use of echocardiography in intensive care medicine].

Transthoracic echocardiography is an easily accessible, non-invasive imaging procedure for evaluation and follow-up of critically ill patients. It is particularly helpful in evaluating patients with thoracic pain, low-output syndrome or heart murmur, and has prognostic value in acute myocardial infarction. It makes a diagnostic contribution in 60 to 90% of cases, and has therapeutic implications in 50 to 65%. New ultrasound technics are briefly discussed.

Aortic Dissection

[Bicavitary cardiac stimulation. Re-assessment and results].

In each indication for cardiac stimulation, dual chamber pacing must be considered if stimulation or sensing in the atrium is possible. It is of particular importance in patients with diastolic ventricular dysfunction. The Heart rate is the most important parameter in stress-adaptation; for this reason we propose to use exclusively the VVIR or DDDR stimulation mode in physically active patients. Complications of dual chamber pacing are rare. During follow-up it is important to limit the energy of impulses and so to enhance the longevity of the generator, and to verify other parameters such as adaptation of the rate adaptation sensor and the AV delay intervals for sensed and paced atrial events. Modern technology allows us to reach the two most important goals of cardiac stimulation: avoid syncopes due to excessive bradycardia or asystole and optimize the quality of life of our patients.

Adaptation, Physiological

The effects of cholecystokinin (CCK-8) on dopamine-containing nerve terminals in the caudate nucleus and nucleus accumbens of the anesthetized rat: an in vivo electrochemical study.

The action of cholecystokinin (CCK) on presynaptic function of dopaminergic nerve terminals has been the subject of much debate in the literature. In efforts to resolve some of the reported ambiguities, high speed in vivo electrochemical recordings were carried out in the caudate nucleus and nucleus accumbens of the urethane anesthetized rat, to determine effects of locally applied sulfated (CCK-8S) and unsulfated (CCK-8US) CCK octapeptide. Locally-applied CCK-8S and CCK-8US caused no increase in the baseline electrochemical signals recorded from either brain region. However, locally applied CCK-8S potentiated the potassium-evoked overflow of dopamine (DA) into the extracellular space in both the caudate and nucleus accumbens. In contrast, pressure ejection of CCK-8US produced no significant effects on the potassium-evoked overflow of DA in either structure. These data support a facilitatory effect of CCK-8S on potassium-evoked overflow from DA-containing nerve terminals in the urethane anesthetized rat that is likely mediated through a peripheral type CCK receptor.

Anesthesia

The effects of delta 9-tetrahydrocannabinol on potassium-evoked release of dopamine in the rat caudate nucleus: an in vivo electrochemical and in vivo microdialysis study.

The effect of systemically administered delta 9-tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana, on the potassium-evoked release of dopamine (DA) was examined in the neostriatum of the chloral hydrate anesthetized rat. Both in vivo electrochemical and in vivo microdialysis techniques were employed. A low dose of THC (0.5 mg/kg, i.p.) increased the time course of potassium-evoked in vivo electrochemical signals corresponding to released extracellular DA. In vivo microdialysis showed an increase in potassium-evoked DA release following 0.5 and 2.0 mg/kg doses of THC. Potassium-evoked electrochemical signals corresponding to released extracellular DA were augmented in time course following i.p. administration (5.0 mg/kg) of nomifensine, a recognized and potent catecholaminergic reuptake blocker. In addition, in vivo brain microdialysis studies of nomifensine (5.0 mg/kg i.p.) on neostriatal potassium-evoked DA release showed that DA levels were augmented in magnitude over the time course of the microdialysis. Taken together, these studies indicate that THC has a potent presynaptic augmenting effect on at least the neostriatal portions of the mesotelencephalic DA system in the rat, although the possibility that this effect could be mediated transsynaptically cannot be ruled out. Given the previous extensive evidence for an involvement of portions of the mesotelencephalic DA system in mediating the reinforcing and euphorigenic properties of many classes of abused drugs, and in mediating direct electrical brain stimulation reward, we suggest that the presently demonstrated effects of THC on forebrain dopamine function may be related to marijuana's euphorigenic properties and, thus, to its abuse potential.

Caudate Nucleus

[Significance of reciprocal ST-segment depression in the acute stage of transmural myocardial infarct].

19 patients with transitory ST-segment depression in the wall opposite the infarcted territory during acute transmural myocardial infarction (AMI) were studied. We investigated the reproducibility of this reciprocal ST depression induced by stress testing and correlated the ECG changes with coronary angiographic evaluation of arteries supplying the remote area. We tried to derive criteria for detection of simple mirror image. 3 different groups were defined according to ECG evolution: Group 1 consisted of 7 anterior and 3 inferior AMI where reciprocal ECG changes disappeared appeared within 24 to 48 hours independently of the ECG changes in the infarcted area. These ST depressions were reproduced by stress testing one to two months later, and correlated angiographically with an anatomic lesion. 7 out of 10 patients later had bypass graft surgery. Group 2 consisted of 7 patients in whom posterior wall extension of an inferior AMI made the diagnosis of anterior ischemia impossible. In another two patients (one anterior and one inferior AMI) reciprocal ST depression and infarcted area ECG changes showed a simultaneous evolution. The reciprocal ST depression could not be reproduced during stress testing and did not correlate with any angiographic lesion. It is concluded that reciprocal ST depression during the acute phase of transmural anterior or purely inferior myocardial infarction is correlated with multivessel coronary disease if their regression is not strictly simultaneous to the infarction-related ECG changes. Further investigations are indicated in these patients.

Acute Disease

[Unstable angina pectoris].

The treatment of unstable angina pectoris should take into account self-regulation, the possibilities for improved oxygen transport, and a reduction of myocardial oxygen requirement. It consists primarily of drug therapy (nitrates, Ca-antagonists, amiodarone, beta-blockers). Secondarily, coronarography is performed with a view to surgical therapy.

Adrenergic beta-Antagonists

[The anti-arrhythmia drug quinidine as an alternative in the treatment of severe falciparum malaria].

Parenteral quinine is the most effective treatment for severe falciparum malaria. It is not easily available in Switzerland and so dangerous delays treating patients may occur. The antiarrhythmic drug quinidine, usually stocked by hospitals, is an alternative drug for malaria treatment. We report the cases of two patients with severe malaria imported from Kenya. They were treated first with intravenous quinidine sulfate over 3 days and for another 4 days with peroral quinidine sulfate. The therapeutic response was excellent. During the 2 months posttherapeutic period no recrudescence of Plasmodium falciparum occurred. 20 mg/kg b.w./die of quinidine given intravenously seems to be an adequate dose in severe falciparum malaria.

Administration, Oral

[A case of acute left myocardial insufficiency after tocolysis by means of beta stimulation].

A case is presented to demonstrate that tocolysis by beta adrenergic stimulation can be complicated by metabolic myocardial infarction. The possible role of pathophysiologic and pharmacologic facts is discussed, but additional clinical features involved in this particular case may be partly responsible for the above-mentioned complication. Finally, some recommendations are made with a view to assessing risk factors and improving cardioprotective effects.

Adrenergic beta-Agonists

[Treatment of rhythm disorders following acute heart infarction using a beta receptor blockader (Visken)].

In a group of 40 patients with acute myocardial infarction and ectopic ventricular or atrial beats or tachycardia, the effect of Visken has been tested by means of 3 i.v. injections of 0.4 mg each at intervals of 15 min. The results showed that Visken has a good effect on these rhythm disturbances and can be administered without danger, provided due regard is had to the contraindications. Beta-blockade is especially indicated when the sinus rate is raised and the conventional antiarrhythmic drugs have proved ineffective.

Blood Pressure