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Biomedical subjects

M Kling

Publications and source records attributed to M Kling.

At least 19 recordsLinked to original sources
PubMed1999

Normal CSF oxytocin and NPY levels in OCD.

BACKGROUND: Attention has recently been focused on central nervous system neuropeptides as potential mediators of the symptom profile of obsessive-compulsive disorder (OCD). Increased CSF levels of the anxiolytic neuropeptide oxytocin have been reported in OCD. CSF levels of NPY, another anxiolytic neuropeptide, have not been studied. METHODS: We measured CSF oxytocin and NPY in 14 OCD patients and 26 healthy normal volunteers. RESULTS: There were no significant differences between the OCD patients and control subjects in CSF oxytocin or NPY levels. In both the OCD and control groups, women had significantly higher CSF oxytocin levels than men. CONCLUSIONS: These results do not support a prior finding of elevated CSF oxytocin in OCD patients and do not provide any evidence for an abnormality of NPY regulation in OCD.

Adult↗
PubMed1997

Gamma delta T cells of human early pregnancy decidua: evidence for local proliferation, phenotypic heterogeneity, and extrathymic differentiation.

The uterine mucosa in pregnancy, the decidua, allows placenta formation and survival of the fetus despite the fact that it is semiallogeneic. Decidua contains large numbers of lymphocytes, of which CD56+ cells dominate, followed by T cells expressing either alpha beta or gamma delta TCR. We have investigated the developmental relationship between the CD56- and TCR gamma delta-expressing cells in early pregnancy decidua using dual labeling immunoelectron microscopy, immunoflow cytometry, and cell fractionation. Lymphocyte subpopulations were, in addition, analyzed for expression of the cytokine receptor for IL-7 and c-kit and for mRNA expression of recombinase-activating genes 1 and 2. Four different cell populations could be distinguished: CD56+bright, CD56+dim/TCR gamma delta+low, CD56+dim/TCR gamma delta+high, and TCR gamma delta+low. Recombinase-activating genes 1 and 2 were expressed in the CD56+bright cells and to a limited degree in CD56+dim/TCR gamma delta+low cells. c-kit was preferentially expressed on the CD56+bright cells, while IL-7R was preferentially expressed on CD56+dim/TCR gamma delta+low and CD56+dim/TCR gamma delta+high cells. The CD56+dim TCR gamma delta+low and CD56+dim/TCR gamma delta+high cells displayed the characteristic morphology of large granular lymphocytes, while single positive TCR gamma delta+low cells were usually smaller and did not contain cytoplasmic granules. The gamma delta 1 gene segment was almost exclusively used in the TCR. Gamma delta T cells in mitosis were seen. We suggest that human early pregnancy decidua is a transient site for extrathymic maturation and that the progenitors of TCR gamma delta+ cells are bone marrow-derived immature cells expressing the CD56 (neural cell adhesion molecule) homing receptor.

Antigens, CD↗
PubMed1997

Preoperative acute hypervolemic hemodilution with hydroxyethylstarch: an alternative to acute normovolemic hemodilution?

Acute normovolemic hemodilution (ANH) may help to reduce demand for homologous blood but requires extra time and apparatus. A more simple procedure is acute hypervolemic hemodilution (HHD), where hydroxyethylstarch is administered preoperatively without removal of blood. In a prospectively randomized study we compared ANH (preoperatively 15 mL/kg autologous blood removal and replacement with 15 mL/kg of hydroxyethylstarch with HHD (15 mL/kg of hydroxyethylstarch administered preoperatively) in 49 patients undergoing hip arthroplasty. To avoid excessive intravascular volume, we used the vasodilating effect of isoflurane. No significant differences were found between groups (ANH, n = 23; HHD, n = 26) for intraoperative blood loss (ANH versus HHD, median [minimum-maximum]); 545 [295-785] mL versus 520 [315-825] mL) and postoperative blood loss (730 [525-945] mL versus 780 [495-895] mL), postoperative hemoglobin, hemotocrit, platelet count or coagulation variables, and transfusion requirements (ANH 43% versus HHD 35% of patients received homologous blood) (P > 0.05). Heart rate did not change significantly in either group. In the ANH group mean arterial blood pressure (MAP) decreased after hemodilution (P < 0.05) while in the HHD group MAP did not change over time. Mean time required to perform ANH was 58 (46-62) min versus HHD 16 (12-19) min (P < 0.05). Costs for ANH were $63.60 USD and for HHD $32.75 USD (labor costs not included). In orthopedic patients undergoing hip replacement with a predicted blood loss of about 1000 mL, HHD seems to be a simple as well as time- and cost-saving alternative for ANH.

Adult↗
PubMed1996

[Neuromuscular and cardiovascular effect of mivacurium in anesthesia induction in patients with renal failure].

OBJECTIVE: Mivacurium produces a prolonged neuromuscular block (NMB) in anuric patients (13), in spite of its rapid hydrolysis by pseudocholinesterase (PChE) which is independent of renal function (17). In the present study the pharmacodynamics and the cardiovascular effects of a bolus dose of mivacurium (0.15 mg/kg) in relation to impairment of renal function were evaluated. METHODS: 60 patients (ASA class 2-4) were assigned to one of three groups according to the degree of renal dysfunction. Creatinine clearance (Krea-Cl) as a measure of renal function was calculated using weight, age, sex and serum creatinine concentrations. Group C (control): Krea-Cl > 50 ml/min; group P (preterminal): 20 ml/min < Krea-Cl < 50 ml/min; group T (terminal): Krea-Cl < 20 ml/min. PChE activity and dibucaine numbers were assessed preoperatively. Neuromuscular transmission (Train-of-Four) was monitored using electromyography (Relaxograph, Datex Inc.) with stimulation of the ulnar nerve. The response was recorded from the hypothenar muscle. Five minutes after induction of anaesthesia with propofol and fentanyl, 0.15 mg/kg mivacurium was given i.v. over 30 s. 150 s later patients were intubated. Anaesthesia was maintained by propofol (2-10 mg/kg/h) and fentanyl (0-5 micrograms/kg/h) infusion. Patients were ventilated with oxygen/nitrous oxide (FiO2 = 0.35). As soon as T1 recovered to 5% or more, mivacurium was administered continuously and this part of the study was finished. Times of onset (onset 10; onsetmax), maximal neuromuscular block (NMBmax), neuromuscular block when intubation was started (NMBTubus), and duration 5% (dur 5) were calculated. Arterial blood pressure and heart rate were recorded before anaesthesia, after induction of anaesthesia, 2-times after mivacurium application, and after intubation. All data were compared using Kruskal-Wallis test corrected for multiple comparisons, Friedman test, or chi 2-test (*: p < 0.05). Logarithms of dur 5 and PChEd were correlated using linear regression. RESULTS: Demographic data were comparable between all groups. PChEd was 3.7 (3.0/4.1) kU/l in group C, 3.2 (2.2/4.8) kU/l in group P, and 3.5 (2.5/4.0) kU/l in group T, respectively. There were no differences between groups, neither in the NMBmax, in NMBTubus, or in onset times. But dur 5 was significantly longer in patients with renal impairment, both preterminal and also end-stage (medians: 11 min in group K, 16 min in group P, 17 min in group T). Emphasis, however, is put on the broad range between 5 and 47 min of dur 5 in group P, and between 6 and 53 min in patients of group T which is clinically more important than the differences in the median values. Dur 5 correlates with PChEd (p = 0.0001). Intubation conditions were excellent (relaxed vocal cords, easy passage of the tube, without coughing) in approximately 70% of all 59 patients without significant differences between groups. In 8 patients conditions were poor (successful intubation, inspite of moderately adducted vocal cords, but moderate coughing after passage of the endotracheal tube). There were no clinically relevant hemodynamic changes in each group in the time between injection of 0.15 mg/kg mivacurium slowly and intubation 2.5 min later. DISCUSSION: Our findings suggest that 0.15 mg/kg mivacurium is an effective and safe intubation dose in healthy patients as well as in patients with renal impairment, inspite of a prolonged duration in patients with renal impairment. Low PChE in some, but not in all patients with a renal dysfunction indicates involvement of impaired hepatic function. There was a close correlation between the PChEd and dur 5. Therefore mivacurium dosage should be reduced in patients with compromised renal function, mainly if there are additional systemic, especially hepatic diseases. Thus, in patients with impaired renal function, relaxometry may be of high valu

Adolescent↗
PubMed1996

[Comparison of the effect of desflurane and isoflurane on neuromuscular blockage with vecuronium on geriatric patients].

Volatile anaesthetics have long been known to intensify the effect of muscle relaxants. In this study we investigated the effects of desflurane and isoflurane on the neuromuscular blockade of vecuronium in geriatric patients. Fifty-two patients requiring elective surgery, aged > or = 65 years, with ASA status II - III were randomly assigned to receive general anaesthesia using desflurane (Des, n = 26) or isoflurane (Iso, n = 26). The effects of both inhalation anaesthetics on the neuromuscular blockade of vecuronium were compared by means of the duration of the depression of the first twitch (T1) of a train-of-four stimulation pattern. Succinylcholine 1.5 mg/kg was used to facilitate intubation, vecuronium 0.05 mg/kg was given as the succinylcholine wore off; additional doses of 0.01 mg/kg were given when T1 exceeded 25% of baseline amplitude. There were no significant differences in the patients' biometric data or the duration of anaesthesia. The median duration of action of the first vecuronium dose (0.05 mg/kg) was: Des: 18.3 (9.4-42.9) min and Iso: 15.9 (3.1-46.0) min. The number of repetitive dosages (0.01 mg/kg) was: Des: 5; 0-13 and Iso: 5; 0-14 and their median duration was: Des: 10.2 (3.6-37.6) min and Iso: 8.9 (2.1-43.9) min. There were no differences between the two groups (p > 0.05). These results suggest that augmentation of neuromuscular blockade by older fluorinated anesthetics is also exhibited by desflurane. The magnitude of this effect in geriatric patients is similar to that of isoflurane.

Aged↗
PubMed1995

Effect of renal function on neuromuscular block induced by continuous infusion of mivacurium.

We have studied the effect of renal function on the pharmacodynamics of mivacurium. Sixty patients were allocated to three groups according to creatinine clearance: group C (control), creatinine clearance > 50 ml min-1; group P (preterminal renal failure), creatinine clearance < 50 ml min-1 > 20 ml min-1; group T(terminal renal failure), creatinine clearance < 20 ml min-1. Neuromuscular transmission (train-of-four) was monitored using electromyography from the hypothenar muscle with stimulation of the ulnar nerve. After an initial bolus, mivacurium was administered continuously to maintain a T1 of 5 (4)% of baseline. The dose of mivacurium necessary to maintain 95% neuromuscular block was similar in patients with normal renal function and patients with different levels of renal impairment. Recovery from neuromuscular block after ceasing mivacurium infusion was significantly prolonged in patients with preterminal renal impairment. There was a close correlation between mivacurium pharmacodynamics and pseudocholinesterase activity, but not creatinine clearance.

Adolescent↗
PubMed1995

Psychopathology in patients with endogenous Cushing's syndrome: 'atypical' or melancholic features.

OBJECTIVE: Prolonged elevations of glucocorticoids have been linked to the effective disturbances experienced by patients with Cushing's syndrome. Major depression has been most commonly reported in patients with endogenous Cushing's syndrome. The purpose of this study was to determine whether these patients experience melancholic or 'atypical' subtype depression and to determine relations between current psychological functioning and factors such as duration and severity of Cushing's syndrome. DESIGN AND PATIENTS: We examined 33 adult patients with documented Cushing's syndrome and 17 hospitalized, matched controls, using standardized structured interviews and tests. RESULTS: During the active phase of Cushing's syndrome (prior to and/or on admission), 66.7% of all patients reported histories meeting criteria for a psychiatric diagnosis. Of those with a diagnosis during Cushing's syndrome, 50% reported major depression. Upon presentation to this institution, atypical depression was the most common diagnosis involving 51.5% (n =17) of all enrolled patients. Of the 17 with atypical depression, 8 reported a co-morbid psychiatric disorder. The duration of Cushing's syndrome was an important factor in predicting whether patients sought psychological intervention or met criteria for psychiatric diagnosis. CONCLUSION: Patients with active endogenous Cushing's syndrome exhibit significant psychopathology expressed primarily by atypical depression. Longer duration of Cushing's syndrome may place them at increased risk of such psychopathology.

Adult↗
PubMed1995

Experiences with the new inhalational agents in low-flow anesthesia and closed-circuit technique. Monitoring and technical equipment.

During recent years interest has focused on two completely fluorinated ethers, desflurane and sevoflurane, which promise a shorter induction of and emergence from anesthesia. Their physicochemical properties differ from isoflurane, enflurane and halothane, thus requiring new technical equipment and leading to a change in anesthesiological procedures. Low-flow anesthesia with desflurane can be performed, the technical equipment is available, especially vaporizers and gas analyzers. In contrast to anesthesia with isoflurane, enflurane and halothane, the initial high-flow wash-in period with desflurane can be shorter and the vaporizer setting can remain unchanged after fresh gas flow reduction. In order to administer desflurane and sevoflurane in closed circuit technique, new technical equipment is needed. Therefore, a computer controlled anesthesia machine was modified and the feedback mechanism to maintain the end-tidal anesthetic concentration was simulated. Isoflurane, desflurane or sevoflurane needed the same time for wash-in. Wash-out was slower with isoflurane; however, the technical equipment should be adapted to increase the elimination of the new agents. The consumption of desflurane and sevoflurane is effectively reduced by low-flow and closed circuit anesthesia.

Aged↗
PubMed1995

[Comparison of the effectiveness of orally administered clorazepate dipotassium and nordiazepam on preoperative anxiety].

Clorazepate dipotassium (Tranxilium) is one of the benzodiazepines which is widely used for oral premedication. After oral administration it is decarboxylated to its active metabolite nordiazepam (desmethyldiazepam). Nordiazepam is also commercially available in the form of drops (Tranxilium N). The aim of the present study was to compare the effect of these drugs on preoperative anxiety. One hundred and eight patients scheduled for orthopaedic surgery (ASA I-II) were studied. Medication was administered at 10 p.m. the evening before surgery (E) and at 7 a.m. on the morning of surgery (M). There were four groups: 1) E no medication; M clorazepate dipotassium; 2) E no medication; M nordiazepam; 3) E clorazepate dipotassium; M clorazepate dipotassium, 4) E clorazepate dipotassium; M nordiazepam. Dosages were: clorazepate dipotassium: body weight < 55 kg: 10 mg; body weight > 55 kg: 20 mg; nordiazepam: 1 gtt/kg; 5 mg = 24 gtt). Anxiety was measured by using the self-evaluating Erlangen anxiety scales, which measure both background and situational anxiety. Background anxiety (EAS-H) was evaluated during the evening before surgery; situational anxiety (EAS-S) was evaluated at the same time and also on the day of surgery before premedication and immediately before surgery. Pulse rate was measured each time the test was administered. There were no differences between the groups in sex, age, weight or the intervals between premedication and anaesthesia induction (p > 0.05). There were no statistically significant differences between the groups with respect to background anxiety. Situational anxiety did not significantly increase or decrease at any of the testing times, nor were there any differences between the groups (p > 0.05). Heart rate did not vary between the groups or with time (p > 0.05). In this group of patients undergoing elective orthopaedic procedures, clorazepate prevented a rise in anxiety in the immediate preoperative period. Since clorazepate is rapidly metabolized to nordiazepam when administered orally it might be predicted that the two drugs have similar properties. This hypothesis is confirmed by the results of the present study. We conclude that orally administered clorazepate dipotassium and nordiazepam have a similar effect on preoperative anxiety.

Administration, Oral↗
PubMed1994

[Hypervolemic hemodilution as a means of preventing homologous blood transfusion. A simple alternative to acute normovolemic hemodilution].

PROBLEM: Acute normovolenic hemodilution (ANH) is timeconsuming and complicated, and has only a small effect in reducing the need for homologous blood. A simpler procedure is hypervolemic hemodilution (HHD). In the present prospective, randomized study, HHD is compared with ANH for its blood-saving effect. STUDY DESIGN: Forty-nine patients undergoing total hip replacement were admitted. Group I (ANH): Withdrawal of 15 ml/kg bodyweight autologous blood and isovolemic replacement by hydroxyethyl starch (200/0.5). Group II (HHD): Infusion of 15 ml/kg bodyweight hydroxyethyl starch (200/0.5). RESULTS: No significant differences were found between the groups in terms of Hb, hematocrit and coagulation. The blood loss (intra-operative+drainage losses) was comparable in the two groups at 1274 +/- 310 ml (HHD) and 130 +/- 335 ml (ANH). During the period under investigation, 66% of the patients in the HHD group and 57% in the ANH group required no homologous blood. CONCLUSION: HHD is just as effective as ANH for reducing homologous blood requirements, and is much simpler to apply.

Blood Loss, Surgical↗
PubMed1994

[Strategies for minimizing homologous blood transfusion in elective interventions].

The risks associated with homologous blood transfusion necessitates the development of strategies for reducing the need for it. The most effective method is certainly preoperative donation of autologous blood, which leads to an increase in the absolute numbers of erythr789789 by the time surgery is performed. Depending on the type of preparation and storage, erythrocytes may be viable for between 49 days (liquid storage) and many years (deep frozen). By employing preoperative plasmapheresis, high-quality autologous fresh frozen plasma can be made available for use during surgery. Donation of autologous blood and plasmapheresis are preoperative measures that need to be organized. Another possibility is the use of a cell separator to recycle blood lost during surgery, and may be applied intra-operatively (aspiration from the surgical wound) or postoperative (drainage). Hemodilution has but little effect in reducing homologous blood requirements. Instead of the technically complex and time-consuming acute normovolemic hemodilution (ANH), the simpler hypervolemic alternative version (HHD) should be employed. Applying all the measures described above, an appreciable reduction in the need for homologous blood can be achieved. A prerequisite, however, is close cooperation between the surgeon an anaesthesiologist.

Blood Transfusion, Autologous↗
PubMed1994

[Anesthesia with the closed PhysioFlex system in comparison with conventional anesthesia procedures].

So far the anaesthetic technique of the closed circuit system in clinical routine could not be used adequately, because suitable mixtures of respiration gas components were not available and the maintenance of a sufficient gas volume in the anaesthetic circle system was not possible with the standard anaesthesia machines. The anaesthesia machine PhysioFlex was especially constructed to deliver anaesthetics in a closed circuit system. In this anaesthesia machine the concentrations of the respiratory gases and the gas volume in the circle system are automatically controlled by a feedback mechanism. We compared the closed circuit system (CC group), with a high-flow system (HF group) and a low-flow system (LF group)--each system on 10 patients. It was noted that the respiratory gas concentrations were adjustable and held constant to a greater degree precise in the circuit system. After the induction the desired inspiratory oxygen-concentration was reached within 5 minutes, the expiratory isoflurane-concentration within 10 minutes in the CC group and was maintained reliable. The consumption of liquid isoflurane was 12.9 ml/h in the HF group, 7.5 ml/h in the LF group and 5.3 ml/h in the CC group. The anaesthetic management was possible without any problems in all three groups.

Adult↗