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Biomedical subjects

R Behr

Publications and source records attributed to R Behr.

36 records · Page 2Linked to original sources
PubMed1998

Heparin-coated equipment reduces the risk of oxygenator failure.

BACKGROUND: The development of an abnormal pressure gradient (APG) across the oxygenator is the most common cause of oxygenator failure during cardiopulmonary bypass. This necessitated changing the oxygenator in 4 patients in this series. A retrospective analysis of conditions predisposing to APG was performed. METHODS: One thousand nine hundred fifty-nine operations with cardiopulmonary bypass were performed in adults. A range of membrane oxygenators was used subject to availability; 769 oxygenators were heparin-coated and 1,190 were uncoated. The pressure gradient across the oxygenator was measured under standardized conditions. An APG was defined as a gradient of greater than twice the mean. RESULTS: An APG occurred in 44 uncoated and 3 heparin-coated oxygenators (p < 0.001). The mean age was higher for the APG group (p < 0.001). Fibrin deposits in the arterial line filter were noted in 45 patients. Logistic regression revealed that only fibrin deposition in the arterial line filter and the use of uncoated oxygenators were significantly associated with APG. CONCLUSIONS: We conclude that a heparin-coated oxygenator effectively prevents APG. This adds significantly to the safety of open heart operations.

Adolescent↗
PubMed1998

Deep hypothermia and circulatory arrest for surgery of complex intracranial aneurysms.

OBJECTIVE: Some intracranial aneurysms may not be operable by conventional neurosurgery due to their location or morphology. Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest renders surgery of these complex aneurysms possible. Brain temperatures can be measured directly in this setting. METHODS: Eight patients with complex intracranial aneurysms were operated on with the aid of CPB. Femoro-femoral bypass with heparin-coated circuit components was used in all cases. Venous drainage was augmented by a centrifugal pump in six patients and by a newly developed vacuum technique in two patients. Temperatures were monitored by probes in brain, tympanum, nasopharynx, bladder, rectum, arterial and venous blood. These measurements were recorded on-line together with those of cerebral oxygen saturation, AP, CVP and PAP. Blood gas analyses and an EEG were also performed continuously. RESULTS: Outcome was excellent in seven patients, in one patient moderate neurological disability occurred. Mean time on cardiopulmonary bypass was 160 (117-215) min, for cooling to a brain temperature of 18 degrees C 33 (20-47) min, and for total circulatory arrest 27 (15-45) min. Additionally, terminal brain arteries were clamped for up to 68 min in four patients. No cardiac complications were observed. Actual brain temperatures were best reflected by the tympanum probes (max. deviation 2 degrees C), whereas temperatures measured in bladder or rectum exhibited deviations of up to 10 degrees C. EEG activities were arrested between brain temperatures of 19 and 26 degrees C. CONCLUSIONS: Complex intracranial aneurysms can be treated successfully using deep hypothermic circulatory arrest. Extensive monitoring adds to the speed and safety of the procedure. The resulting comparative measurements of temperatures at different body sites including brain, EEG, and other variables may be of general relevance for operations employing deep hypothermia and circulatory arrest.

Adult↗
PubMed1998

Testicular cAMP responsive element modulator (CREM) protein is expressed in round spermatids but is absent or reduced in men with round spermatid maturation arrest.

Mice lacking the functional cAMP responsive element modulator (CREM) gene, a component of cAMP-mediated signal transduction, exhibit a specific arrest of round spermatid development although follicle stimulating hormone (FSH) and androgen secretion are not impaired. We studied testicular expression of CREM protein by immunocytochemistry in four patients with complete spermatogenesis (obstructive azoospermia), in 20 infertile patients with round spermatid maturation arrest (n = 10) or mixed atrophy (n = 10) and in six prostate cancer patients undergoing orchidectomy. Concentrations of testosterone were below normal in three patients. Concentrations of luteinizing hormone (LH) were lowered in two patients and elevated in one patient. FSH concentrations were above normal in ten patients. During normal spermatogenesis, CREM was expressed in nuclei of round spermatids in stages I-III of spermatogenesis but not in elongating spermatids. Western blot analysis of testes from prostate cancer patients indicated a major CREM band of approximately 35 kDa. Among patients with predominant round spermatid maturation arrest, CREM expression was significantly reduced (P < 0.05) or undetectable as revealed by quantitative image analysis. CREM-negative spermatids failed to progress beyond stage III of spermatogenesis. Our observations suggest a role for CREM in human spermatid development and raise the possibility that altered CREM expression could be associated with spermatid maturation defects in some cases of idiopathic male infertility.

Adolescent↗
PubMed1997

Early and longtime modifications of temperature regulation after severe head injury. Prognostic implications.

In summary, despite almost normal body temperatures in thermoneutrality, thermoregulatory characteristics in posttrauma patients are evidently altered and modified. These changes make the patients more susceptible to variations of the ambient temperatures and reduce their ability to counteract heat loads. They are more in danger of suffering heat stroke under external thermal load and during work or sport activities. In certain cases this could mean an important reduction of the daily quality of life.

Adult↗
PubMed1997

Effects of desflurane and isoflurane on systemic vascular resistance during hypothermic cardiopulmonary bypass.

OBJECTIVE: The objective of this study was to examine the dose-related effects of desflurane and isoflurane on systemic vascular resistance during hypothermic cardiopulmonary bypass. DESIGN: Randomized, prospective trial. SETTING: University hospital. PARTICIPANTS: Sixty consenting patients, 65 years of age or older, scheduled for elective coronary artery surgery. INTERVENTIONS: Patients were randomly allocated to one of five groups to receive 0.5 or 1.0 minimum alveolar concentration (MAC) (exhaust gas concentration) desflurane or 0.5 or 1.0 MAC isoflurane during hypothermic (32 degrees to 33 degrees C) nonpulsatile cardiopulmonary bypass or to a control group that did not receive any anesthetic agent. Systemic vascular resistance index was recorded at baseline, every 2 minutes for the first 10 minutes during initial administration and every 5 minutes for another 15 minutes during maintenance of anesthesia. MEASUREMENTS AND MAIN RESULTS: In patients receiving 0.5 MAC desflurane and isoflurane, there were significant differences in systemic vascular resistance index only at 20 and 25 minutes compared with control values. In the desflurane 1.0 MAC group, significant decreases were observed at 15, 20, and 25 minutes compared with controls. In the 1 MAC isoflurane group, the 10-, 15-, 20-, and 25-minute value differed significantly from the control. There were significant decreases in systemic vascular resistance index in the 1.0 MAC groups at 20 and 25 minutes compared with 0.5 MAC values, as well. CONCLUSIONS: Equi-MAC concentrations of desflurane and isoflurane had similar effects on systemic vascular resistance; 0.5 MAC maintained systemic vascular resistance; 1.0 MAC decreased systemic vascular resistance during hypothermic cardiopulmonary bypass.

Aged↗
PubMed1996

Comparison of thermoregulatory characteristics of patients with intra- and suprasellar pituitary adenomas.

Thermoregulatory capabilities under physiologic cold and heat exposure of 37 patients with suprasellar pituitary adenomas (As) and 10 patients with intrasellar adenomas (Ai) were analyzed and compared to each other and to 13 controls (Ctr.) In Ai no shift of the thermoregulatory threshold temperatures was observed. In As the regulation was shifted to a 0.5 degrees C higher mean body temperature in 82% of the patients, indicating a "set-point" elevation. The accuracy of the regulation against thermal loads was maintained, the velocity was reduced. Postoperative examination of As revealed a normalisation of the "set-point". Modifications of the hypothalamic amine systems by the compressive effect of the suprasellar adenomas are discussed to be the most probable cause for the observed thermoregulatory alterations.

Adenoma↗
PubMed1996

Temperature regulation as possible prognostic indicator in patients with acute intracranial lesions.

24 patients, 16 after severe head injury and 8 after spontaneous intracranial haematoma, were investigated by external cold load in order to determine their thermoregulatory capabilities. Tympanic temperature, several skin temperatures and oxygen consumption were measured. The patients where examined for SSEP and AEP. The cold induced thermoregulatory threshold temperature was determined by calculating the mean body temperature and by determining mean body temperature at which oxygen consumption increased due to the external cold load. In all patients core temperature and mean body temperature were significantly elevated by 1 degree C compared to controls. There was no difference of the course of the various body temperatures during cold load in the patient groups. In the trauma group 8 patients were able to increase oxygen use (VO2) during cold exposure, the other 8 patients showed no physiological thermoregulatory reaction. The heatproduction threshold temperature was increased by 1 degree C in the patient groups compared to controls. There was no significant correlation of AEP and SSEP findings to a preserved or disturbed thermoregulatory reaction. In the trauma patients, who were able to respond to a cold load, the outcome was significantly better (GOS = 3-5), than in those patients, who did not show a physiological increase of VO2 due to the cold load (GOS = 1-2). In conclusion, measurement of body temperatures alone is not sufficient to determine termoregulatory capacities. An examination using thermophysiological methods however provides more information about the function and structure damaged after severe head injury. An intact thermoregulatory systems seems to be correlated with a better prognosis after head injury.

Adolescent↗
PubMed1996

Opportunities on the Internet for child and adolescent psychopharmacologists: net access and mailing lists.

The Internet, a system linking computers around the world, provides clinical and research psychopharmacologists with a convenient and efficient way to exchange information and offers a growing number of services to facilitate patient care. These opportunities are not theoretical, not in the future, and not for a select few. Many patients are already benefitting from practitioners who have sought guidance for their clinical work on the Internet. This article describes, for the novice user, how to begin the Internet journey. It also discusses psychopharmacology-related mailing lists, including a site that specializes in child and adolescent psychopharmacology. Subsequent articles will (1) show how to use Medlines to conduct literature searches and retrieve abstracts and articles from the computer screen, (2) describe ways to enter and traverse the World Wide Web (the "multimedia" portion of Internet), and (3) survey the use of "Web browsers" to find specialized psychopharmacology resources and databases, electronic journals, pertinent bulletin boards, and support services for patients and families-all with an emphasis on direct benefits to the practicing psychopharmacologist.

Computer Communication Networks↗
PubMed1994

Development of resistance by Enterobacter cloacae during therapy of pulmonary infections in intensive care patients.

The emergence of resistance during therapy and the efficacy of different antibiotic therapy regimens were studied in 38 intensive care patients suffering from pulmonary infections caused by Enterobacter cloacae. Every three days a fresh isolate was obtained from each patient and tested in vitro for susceptibility to 16 antibiotics by determination of the minimal inhibitory concentrations. During therapy with cefotaxime and tobramycin the E. cloacae strains from 47% of the patients became resistant to cefotaxime within 6 days. In all cases resistance encompassed all other broad-spectrum penicillins and cephalosporins tested, as well as aztreonam. Development of resistance regularly led to persistence of bacteria. Resistance to tobramycin, ciprofloxacin or imipenem was not observed. Treatment of 25 patients with persisting E. cloacae infections was successful in 17 out of 18 patients treated with imipenem and in 6 out of 7 patients receiving ciprofloxacin.

Adolescent↗
PubMed1993

[Anesthesia in familial hyperkalemic periodic paralysis].

A 53-year-old woman was scheduled for elective surgery of a L4-L5 lumbar disc prolapse. Preoperatively, she reported of a hereditary muscle disease in her family which could be identified as familial hyperkalaemic periodic paralysis. In patients with familial periodic paralysis, only limited information is available in the current anaesthesiological literature. This is especially true of the hyperkalaemic form which was separated from the hypokalaemic form in 1957. Most patients suffering from periodic paralysis will develop myotonic symptoms in time, but evidence is lacking that the incidence of malignant hyperthermia (MH) is higher than in normals. However, abnormalities of the electrocardiogram (ECG) due to changes in the potassium serum levels are not unusual, and the anaesthesiologist must be aware of cardiac arrhythmias. In the present case, the patient was anaesthetized using fentanyl, midazolam, and vecuronium, and ventilated with 66% nitrous oxide in oxygen. Radial artery blood pressure, end-tidal CO2, and nasopharyngeal temperature were monitored continuously. Surgery was completed after 2 hours with no abnormalities in the intraoperative course. Recovery from anaesthesia was uneventful. During the postoperative follow-up for 1 week, further attacks of paralysis, intermittent sodium-potassium imbalance of the muscle cell membrane appears to be the primary pathogenetic factor. In this special disease, prevention of carbohydrate depletion and the avoidance of muscle relaxants are recommended in the anaesthesiological literature. However, a specified regimen of general anaesthesia has not yet been outlined. In our special case, the use of anaesthetics deemed to be safe in MH susceptible patients produced an uneventful perioperative course.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, General↗
PubMed1991

Modifications of thermoregulation in patients with suprasellar pituitary adenomas.

Thermoregulation was investigated pre and postoperatively in 5 and only preoperatively in 7 patients with suprasellar pituitary adenomas by exposing them to external cold and heat in a climatic chamber. Five healthy subjects served as controls. Body core and skin temperatures, oxygen consumption, electromyographic activity, skin blood flow and local sweating rates were continuously measured. Threshold temperatures for activation of heat production and heat loss were calculated from these data. Hormone analysis was performed before and after stimulation with releasing factors. In the patients, core temperatures as well as threshold temperatures for heat production and heat loss were elevated by about 0.5 degrees C as compared with controls. This elevation of core and threshold temperatures was achieved, despite a reduced resting metabolic rate, by a reduction of skin blood flow indicated by a low mean skin temperature. After successful operation the thermoregulatory alterations normalized. Serum levels of growth hormone were reduced preoperatively and stimulation by GHRF did not cause an appropriate increase. Prolactin was elevated in 6 patients with prolactinomas, but there was no correlation with changes in thermoregulatory threshold temperatures. Stimulation of the other hypophyseal hormones by the combined anterior pituitary function test revealed a normal hormonal response. Apart from prolactin there were no significant hormonal changes postoperatively. It is concluded that disturbances of temperature regulation are present in patients with suprasellar adenomas, but that they are not detectable by routine clinical methods. These alterations probably depend on a disturbance of hypothalamic function and are reversible by surgery.

Adenoma↗
PubMedDate not supplied

Round spermatids show normal testis-specific H1t but reduced cAMP-responsive element modulator and transition protein 1 expression in men with round-spermatid maturation arrest.

During spermiogenesis, histones are replaced by transition proteins, which in turn are replaced by protamines. The TNP1 gene-encoding TP1 (transition protein 1) protein contains a cAMP-responsive element (CRE) that serves as binding site for the CRE modulator (CREM). To gain further insight into the complex regulation of nucleoprotein exchanges in haploid spermatids and its potential role for spermatogenic impairment, we studied the gene expression of testis-specific histone H1t, CREM, and TNP1 in testicular biopsies from men with normal spermatogenesis (n = 20) and with round spermatid maturation arrest (n = 16). During normal spermatogenesis, H1t messenger RNA (mRNA) was present in 86.2%+/-8.7% of pachytene spermatocytes (stages III-V), whereas H1t protein was synthesized in 83.5%+/-13.0% of pachytene spermatocytes (stages III-V) and persisted in 95.2%+/-3.1% of spermatids (steps 1-5). CREM mRNA was detectable in 74.2%+/-9.4% of pachytene spermatocytes (stages IV-V) and in 78.7%+/-10.0% of spermatids (steps 1-3). CREM protein was synthesized in 81.2%+/-14.2% of spermatids (steps 1-3). TNP1 mRNA was present in 80.0%+/-13.5% of spermatids (steps 2-4), whereas TP1 protein was synthesized in 89.7%+/-5.3% of spermatids (steps 3-4). In men with round spermatid maturation arrest, spermatids only develop to step 3 of differentiation. These spermatids were devoid of both CREM and TP1 but did contain H1t. These results indicate that TP1 is likely to be an important parameter in the histone-to-protamine exchange and in the initiation of spermatid elongation. CREM is involved in the regulation of TNP1 gene expression and consequently plays a vital role in the correct differentiation step from round spermatids to mature spermatozoa.

Chromosomal Proteins, Non-Histone↗
PubMedDate not supplied

Rupture of giant cerebral aneurysms during angiography. Case report and review of literature.

A case of a giant aneurysm of the internal carotid artery which ruptured during cerebral angiography is reported. 30 other cases from literature of the last 35 years are reviewed. The majority of aneurysms ruptured during angiography was located at the internal carotid artery. 21 out of 30 patients were females. Fatal outcome was connected in general with intracerebral or intraventricular hemorrhage. Factors connected with the examination procedure and therapy are discussed.

Adult↗