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Biomedical subjects

T Kramer

Publications and source records attributed to T Kramer.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Manometric follow-up after resection of Zenker's diverticulum].

Since 1977, 15 patients have undergone surgery for Zenker's diverticula at the University of Würzburg Department of Surgery. We were able to follow up 6 of them after an average of 4 years (5 months to 10.5 years). Preoperative manometric findings available on one patient revealed markedly impaired coordination between pharyngeal contraction and relaxation of the upper esophageal sphincter. After resection of the diverticulum and myotomy of the upper sphincter this was not observed in any of the patients. Myotomy also was followed by significant lowering of resting pressure in the upper esophageal sphincter to mean levels of 18 mm Hg (normally 90-100 mm Hg). By contrast, one patient who did not undergo intraoperative myotomy had only a moderate reduction of resting pressure (to 30-45 mm Hg) and a normal maximum contraction pressure of 100 mm Hg. This patient developed a relapse. Our manometric evidence underscores the importance of intraoperative myotomy as an adjunctive procedure in diverticulum resection. By helping reduce the resistance imposed by interference of impaired coordination with pharyngeal contraction, it also results in a lower rate of relapse.

Aged↗
PubMed1991

Topographical requirements for delta opioid ligands: presence of a carboxyl group in position 4 is not critical for deltorphin high delta receptor affinity and analgesic activity.

To investigate the role of the carboxyl group in deltorphin molecules, we have synthesized three new analogues in which the acidic amino acid residues in position 4 of the deltorphins were replaced by non-acidic but hydrophilic amino acids residues. The three analogues, [Ser4]-, [Gln4]-, and [Cys4]-deltorphin, all are as potent or more potent than either deltorphin I or II at delta opioid receptors and possess good delta selectivities. The excellent correlation between their in vitro delta receptor potencies and their intrathecal antinociception activity forms a strong argument for involvement of those receptors in spinal nociceptive modulation in the rats.

Amino Acid Sequence↗
PubMed1991

Opioid receptor binding properties of analgesic analogues of cholecystokinin octapeptide.

Four analogues of cholecystokinin (CCK) octapeptide having analgesic activity after i.c.v. administration and high affinity for CCK-B receptors were studied for their ability to displace specific ligands, [3H]D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2. [3H][D-Pen2, 4'-Cl-Phe4,D-Pen5]enkephalin and [3H]U-69,593, for mu-, delta- and kappa-opioid receptors, respectively. None of the analogues tested have high affinity for either mu- or kappa-receptors (IC50 values greater than 0.7 microM), but their IC50 values for delta-receptors range from 29 to 1023 nM. The results suggest a relationship between the ligand requirements of CCK-B and delta-opioid receptors which further implies a possible structural relationship between these receptors.

Amino Acid Sequence↗
PubMed1991

Molteno implants and operating microscope-induced retinal phototoxicity. A clinicopathologic report.

The right eye of a 75-year-old man with a history of cataract extraction, three penetrating keratoplasties, laser trabeculoplasty, two Molteno implants, and an operating microscope-induced retinal phototoxic lesion was studied post mortem. Histopathologic examination of the anterior segment showed evidence of penetrating keratoplasty, cataract surgery, and two Molteno implants with minimal associated tissue response. Ultrastructural examination showed a loose collagenous matrix surrounding the Molteno reservoirs, suggesting aqueous percolation from the reservoirs into the conjunctiva. Posteriorly, in the area of the phototoxic operating microscope-induced lesion, a nodule of retinal pigment epithelial hyperplasia with overlying atrophy of the photoreceptor cell layer of the neurosensory retina was noted. The retina also contained cystoid macular edema and an extensive preretinal membrane that was clinically unexpected.

Aged↗
PubMed1991

Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding.

OBJECTIVE: To measure the effects of supportive companionship on labour and various aspects of adaptation to parenthood, and thus by inference the adverse effects of a clinically orientated labour environment on these processes. DESIGN: Randomized controlled trial. SETTING: A community hospital familiar to most of the participants, with a conventional, clinically-orientated labour ward. SUBJECTS: Nulliparous women in uncomplicated labour. INTERVENTION: Supportive companionship from volunteers from the community with no medical nor nursing experience, concentrating on comfort, reassurance and praise. MAIN OUTCOME MEASURES: Duration of labour, use of analgesia, perceptions of labour and breastfeeding success. RESULTS: Companionship had no measurable effect on the progress of labour. Diastolic blood pressure and use of analgesia were modestly but significantly reduced. The support group were more likely to report that they felt that they had coped well during labour (60 vs 24%, P less than 0.00001). Their mean labour pain scores (26.0 vs 44.2, P less than 0.00001) and state anxiety scores (28.2 vs 37.8, P less than 0.00001) were lower than those of the control group. Compared with the control group (n = 75), at 6 weeks women in the support group (n = 74) were more likely to be breastfeeding exclusively (51 vs 29%, P less than 0.01); and to be feeding at flexible intervals (81 vs 47%, P less than 0.0001). CONCLUSIONS: Labour in a clinical environment may undermine women's feelings of competence, perceptions of labour, confidence in adapting to parenthood and initiation of successful breastfeeding. These effects may be reduced by the provision of additional companionship during labour aimed to promote self-esteem.

Analgesia, Obstetrical↗
PubMed1991

Reduced survival of neonates due to vitamin A deficiency during pregnancy in the guinea pig.

Neonatal vitamin A stores are limited even in well-nourished full-term infants and are yet smaller in the premature infant. The object of this experiment was to determine whether vitamin A deficiency could be induced in pregnant guinea pigs and, if so, whether it would affect vitamin A status of the neonate. Adult (600 g) guinea pigs were fed a casein-agar diet that was vitamin A deficient (AD). Controls (vitamin A adequate) were orally dosed weekly with 2 mg of retinyl palmitate. Weight gains of dams and birth weights of neonates did not differ. No external signs of deficiency were observed. Six of eight AD and seven of eight vitamin A-adequate dams carried pregnancy to term (greater than or equal to Day 64). One AD dam died during delivery. Liver retinol concentrations were below the detection limit (less than 3 micrograms/g) for all AD neonates and dams and in postpartum serum of AD dams. Of neonates born greater than or equal to Day 64, 15 of 18 AD were dead or moribund compared with 4 of 22 vitamin A adequate. The unexpectedly severe effect on the neonate indicates that the guinea pig will be a sensitive model for investigating the affect of poor maternal vitamin A status on neonatal vitamin A-dependent functions. However, a less severe maternal deprivation should be used for such studies.

Animals↗
PubMed1991

[Zenker's diverticulum. Long-term results after surgical therapy].

Twenty-one patients were treated for Zenker's diverticulum in the Würzburg University Department of Surgery between 1977 and 1989. Surgery was done in 15 cases (8 single-session resections with myotomy of the upper esophageal sphincter, and 7 resections without myotomy). The postoperative course was uneventful in 73%. Wound infection developed in 2 cases, and suture insufficiency and transient paralysis of the recurrent nerve in one each. In 3 patients, postoperative x-ray prior to release from the hospital revealed retention of contrast medium in a discrete, pocket-like protrusion between the cricoid and the pharynx. Follow-up was done after a mean interval of 4 years (range: 5 months-10.5 years) in 10 of the 15 operated patients. Two of them developed relapses about 1-1.3 cm in size within 8 months and 7 years, resp. Myotomy had not been done in either case. Neither patient had complaints. Esophageal manometry was performed in 6 patients. Resting tone of the upper esophageal sphincter was clearly diminished at 12-30 mm Hg (normal 40-50 mm Hg); maximum contraction pressure was also reduced at 30-75 mm Hg (normal 90-110 mm Hg). However, the decisive factor was the exact temporal coordination of pharyngeal contraction with sphincter relaxation. For this reason it is our unconditional recommendation that myotomy of the upper esophageal sphincter be regarded as an essential step in resection of Zenker's diverticula.

Adult↗
PubMed1991

Administration of clonazepam in the treatment of TMD and associated myofascial pain: a double-blind pilot study.

A double-blind pilot study was undertaken to test the administration of low doses of the long-acting benzodiazepine drug clonazepam in the management of chronic intractable temporomandibular disorder/myofascial pain patients who were not responsive to occlusal splint, behavioral, and physical therapy. Clonazepam was selected for its long duration and its cholinergic/GABA-ergic/serotonergic, anxiolytic, muscle relaxant, and sedative properties. Clonazepam appears to be effective when compared to a placebo. However, caution must be observed with long-term administration of clonazepam because of potential side effects such as depression and liver dysfunction. Indiscriminate administration of clonazepam may be harmful to the patient.

Adolescent↗
PubMed1990

Decreased choroidal blood flow associated with retinitis pigmentosa.

The intraocular pressure pulse has been measured and used to evaluate the ophthalmic arterial pressure and the ocular pulsatile blood flow in 13 retinitis pigmentosa patients and ten similar aged healthy volunteers. The light sensitivity thresholds of the central fields of all persons were recorded using the Heijl-Krakau automated perimeter. The mean pulse amplitudes of 1.2 +/- 0.2 (26) and 2.3 +/- 0.25 (20) mmHg in the affected and in the control groups respectively differed significantly (p less than 0.001). The corresponding pulsatile blood flows were 310 +/- 24 (26) and 628 +/- 40 (20) microliters min-1. The mean ophthalmic arterial pressures in the two groups were equal. The light sensitivities in pairs of eyes of four of the patients differed substantially and in all cases the eye with the better visual performance had the higher ocular pulsatile blood flow. It is concluded that relative choroidal ischaemia is closely associated with visual loss and pigment cell degeneration in patients with retinitis pigmentosa.

Adolescent↗
PubMed1989

DMI-measured defenses and HIV-related risk behaviors in i.v. compared to non-i.v. substance abusers.

The Defense Mechanism Inventory (DMI) and The Risk Behavior Inventory (RBI) were administered to substance abusers hospitalized on a drug detoxification service. The groups were categorized on the basis of self-reported IV versus non-IV substance abuse. Significant between-group differences were obtained on the DMI and RBI. The non-IV group responded less often than the IV group with the Turning Against Object (TAO) response option, resulting in higher scores when Turning Against Self (TAS), Reversal (REV), Principalization (PRN) and Projection (PRO) were summed into a single score. Significant within-group differences were obtained for DMI response levels and defenses. Both groups relied less on TAO at the thought level and more on PRN and REV as primary defenses. The IV group reported twice as many risk behaviors as the non-IV group and risked HIV exposure through needle use and sexual transmission modes. Consideration was given to the role of principalization and denial within the addicted individual's defense structure and the relationship of these defenses to HIV-related risk behavior.

Adult↗
PubMed1988

Intra-operative radiation therapy in the treatment of pelvic malignancies: a preliminary report.

Local control of advanced pelvic malignancies, particularly when complete surgical resection is not feasible, is often impeded by dosage limitations in radiation therapy and the intolerance to radiation of normal tissues. This is a preliminary report on the feasibility of improved local control in pelvic malignancies treated by intra-operative radiation therapy, as a radiation boost, in addition to conventional surgical resection and external beam radiation therapy. Fifteen gynaecological malignancies (five cervix, five uterus, four ovary, and one vulva) from Rush Medical College and the University of Navarre, as well as 36 other pelvic malignancies (32 colorectal, 4 genito-urinary) from Rush Medical College were reviewed. All tumours were advanced or recurrent, and all patients were felt to be at high risk of local failure. IORT was administered at a dose range of 10-26 Gy. Our data suggest that the probability of local control improves when IORT is used for primary and for microscopic disease, when the tumour is at least partially resectable, and when the total dose given in IORT and external beam radiation exceeds 70 Gy.

Brachytherapy↗
PubMed1985

Improved control in advanced head and neck cancer with simultaneous radiation and cisplatin/5-FU chemotherapy.

Chemotherapy with cisplatin plus 5-FU infusion was given simultaneously with radiation therapy; both were administered every other week. Twenty-seven patients with stage IV disease and three with stage III disease were treated; 57% had T4, 33% had N3, and 10% had M1 disease. Of these patients, 17 (57%) achieved complete response and the rest achieved partial response. However, whether or not a clinically complete response occurred had no effect on subsequent risk for disease recurrence. With a median follow-up of 16 months (range, 6-35), only 11 patients (37%) have had disease recurrence and eight (27%) have died. Of those patients who recurred, six failed in distant sites only, one developed a second head and neck primary, and four (36% of all failures) failed regionally. Normally, greater than 50% of patients who are initially controlled (usually less than 60% of stage IV patients) would have failed within the first 12 months and greater than or equal to 75% of these would be expected to fail regionally. Nine patients who had received previous treatment or who had M1 disease accounted for six of the recurrences and four of the deaths. Because of the excellent local control, we have cautiously limited surgery to conserve laryngeal, tongue, and mandibular function in selected cases. Neither immediate nor long-term toxicity from radiation appeared increased. Although no patient with such advanced disease can be considered cured at this time, these results seem to represent a substantial improvement in the quality of life and degree of local control over other approaches. Controlled trials of the sequencing of radiation and chemotherapy in head and neck cancer appear indicated.

Aged↗
PubMed1980

Reye syndrome in Ohio, 1973-1977.

Some major epidemiologic features of Reye syndrome have been elucidated since the first description of this clinical entity. Multiple studies have shown an association with epidemic influenza B and endemic varicella. Little population data are available on age, sex, race, geographic distribution, and secular trends. A five-year retrospective population-based study of 190 Ohio residents diagnosed with Reye syndrome from January 1, 1973-December 31, 1977, is reported here. The temporal relationships between the occurrence of Reye syndrome and influenza B and varicella were confirmed; however, a high number of blacks and city dwellers with Reye syndrome were found in this study.

Adolescent↗
PubMed1977

Delayed wattle reaction as a measure of cell-mediated immunity in the chicken.

The cell-mediated immune (CMI) response to diphtheria toxoid (DT) was studied in commercial broiler breeder lines. The chickens were immunized with DT in complete Freund's adjuvant 21 days before CMI assay by delayed wattle reactivity (DWR) to DT. The DWR was shown to be a valid measure of CMI and to correlate with spleen cell migration inhibition and blastogenesis assays of CMI in vitro. In addition, each criterion of CMI was met, except for the passive transfer of DWR. These criteria were delayed timing, gross morphology, histopathology of DWR, and effect of antilymyphocytic sera on DWR. The duration of DWR over a 1-year period differed in the two lines of chickens tested. A significantly greater DWR was found in one line with all birds remaining reactive for CMI whereas in the other line 16% did not have CMI by the end of the year. The differences may reflect genetic variability within and between lines in expression of CMI.

Animals↗