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Biomedical subjects

T Winkler

Publications and source records attributed to T Winkler.

At least 19 recordsLinked to original sources
PubMed1992

Cardiopulmonary bypass for resuscitation of patients with accidental hypothermia and cardiac arrest.

Hypothermic patients have been successfully rewarmed by a number of methods. However, when cardiac arrest occurs, as it frequently does at core temperatures of less than 27 degrees C, prolonged cardiopulmonary resuscitation (CPR) is required, because defibrillation can rarely be achieved until the patient has been rewarmed to 30 degrees to 34 degrees C. Five cases of accidental hypothermia with cardiac arrest treated with cardiopulmonary bypass are discussed. The first patient died as a result of inadequate low-flow cardiopulmonary bypass by the femorofemoral route. The second patient had prolonged CPR by closed-chest cardiac massage and warm peritoneal lavage followed by transthoracic cardiopulmonary bypass. This patient regained consciousness but was found to be paraplegic and died from bowel infarction related to peritoneal rewarming without adequate perfusion. In the last three patients, high-flow cardiopulmonary bypass was rapidly achieved using a no. 28 French chest tube for femoral venous cannulation, and they recovered completely. In cases of accidental hypothermia with cardiac arrest, rapid institution of full cardiopulmonary bypass provides excellent circulatory support and rapid rewarming. This avoids the complications of prolonged inadequate circulation that occur when closed-chest cardiac massage and external rewarming are used.

Adult↗
PubMed1991

Uni- and bipolar surface recording of human nerve responses.

Nerve conduction studies are of great clinical value in diagnosing nerve pathology and injury. In most neurophysiological laboratories nerve conduction recordings are routinely made with surface bipolar electrodes. More rarely, needle electrodes are used. A bipolarly recorded nerve action potential (NAP) is the difference between 2 unipolar NAPs recorded from each pole of a bipolar electrode and a remote reference. The delay between the 2 separated unipolar NAPs depends on the distance between the poles and the conduction velocity (CV). When the delay between the unipolar NAPs was increased (partly through simulation), the following changes of the bipolar NAP occurred: (1) total amplitude was maximal at a certain delay but decreased if the delay was shorter or longer, (2) latencies of the first positive and the first negative peaks increased slightly until their amplitudes reached maximal values, (3) a second negative peak of increasing latency appeared with longer delays, (4) latencies of later peaks increased linearly, and (5) total area increased nonlinearly. All parameters of the bipolarly recorded NAP (except the onset of the first positive phase) changed with increasing delay. The significance of this is that if NAPs are recorded with a bipolar electrode, standard values obtained for each nerve cannot be transferred between laboratories if different interelectrode (interpolar) distances are used. Furthermore, the assumption that a fixed interelectrode distance allows comparisons between reference values and patient data is incorrect.

Action Potentials↗
PubMed1991

Evaluation of traumatic spinal cord edema using evoked potentials recorded from the spinal epidural space. An experimental study in the rat.

Spinal cord evoked potentials (SCEP) elicited by simultaneous distal tibial and sural nerve stimulation were continuously recorded from the epidural space at the T9 and T12 levels of urethane anaesthetized rats before and after a unilateral incision (about 3 mm deep and 5 mm long) in the right dorsal horn of the T10-11 segments. The changes in SCEP were correlated with the increase in spinal cord water content measured 5 h after injury. In addition, the influence of serotonin (5-HT) in mediating such changes was explored using a pharmacological approach. The changes in SCEP immediately after injury correlated well with development of spinal cord edema measured 5 h after injury. Thus, the maximal negative peak (MNP) amplitude of SCEP decreased by an average of 64.0% immediately after injury and the water content of the spinal cord was increased from 71.6% (controls) to 77.6% 5 h after injury. Pretreatment with p-CPA (a serotonin synthesis inhibitor) prevented the initial decrease of the MNP amplitude and also the increase of water content (72.5%). On the other hand, pretreatment with cyproheptadine (a 5-HT2 receptor antagonist) enhanced both the initial decrease of the MNP amplitude as well as the increase of water content (81.3%). The results show a good correlation between changes of SCEP immediately after injury and the magnitude of spinal cord edema (r = 0.9) measured 5 h after injury. The findings reveal a major role of serotonin in mediating early changes of SCEP and later development of spinal cord edema and demonstrate a prognostic value of early SCEP recordings in predicting the final outcome of traumatic spinal cord injuries.

Animals↗
PubMed1991

Human anti-mouse antibody response induced by anti-CD4 monoclonal antibody therapy in patients with rheumatoid arthritis.

The development of human anti-mouse monoclonal antibodies (HAMAs) was investigated in 10 patients with rheumatoid arthritis (RA) who had undergone an experimental therapeutic trial with an anti-CD4 monoclonal antibody. In this patient group, the antibody 16H5 of the IgG1 isotype had been administered in a median total dosage of 140 mg per treatment cycle. Four patients took part in a second treatment regimen 6-8 weeks later. After the first treatment cycle, detectable HAMAs developed in 5 out of 10 patients. In 4 individuals undergoing a second course of therapy, increases of HAMAs were evident only in the 3 patients with previous HAMA responses. HAMAs were primarily of the IgG isotype, while the presence of rheumatoid factors usually interfered with the detectability of IgM HAMAs. However, using isolated F(ab)2 fragments of the monoclonal reagent used for therapy, HAMAs of the IgM isotype were also detectable. HAMAs of the IgG isotype did not exceed levels of 2.0 mg/liter after a single treatment cycle and 2.2 mg/liter after a repeated cycle. No IgE responses were detectable. Absorption experiments indicated that approximately 25% of the HAMA activity was directed against specific determinants of the 16H5 monoclonal antibody, presumably including anti-idiotypic reactivities. These data demonstrate that HAMAs developed only in a proportion of RA patients treated with the anti-CD4 monoclonal antibody 16H5. However, the amounts were rather low compared to other monoclonal reagents used in cancer patients and were therefore allowed for repeated applications without an apparent loss of efficacy.

Antibodies, Monoclonal↗
PubMed1990

Functional and pharmacokinetic studies of tetrahydroaminoacridine in patients with amyotrophic lateral sclerosis.

Assuming the presence of clinically significant cholinergic hypofunction in amyotrophic lateral scleroses (ALS), seven patients with ALS were treated with 100-200 mg tetrahydroaminoacridine (THA) together with 11 g lecithin daily for up to 7 weeks. In a separate experiment pharmacokinetics and effects on muscle strength and neurophysiological parameters were studied following the injection of 30 mg THA intravenously. Following the injection of THA an increase in muscle strength was observed in two patients. There were no consistent pharmacokinetic differences that could explain the effect on intravenous THA on muscle strength in these two patients. The plasma clearance of THA was high and the oral bioavailability low with large interindividual differences (6-36%). No beneficial effect was seen during oral medication and side-effects were common. There were no conclusive changes observed regarding neurophysiological parameters after drug administration. THA has probably no place in the treatment of ALS.

Administration, Oral↗
PubMed1988

Surface anodal stimulation of human peripheral nerves.

Bipolar surface stimulation of human peripheral nerves with short square pulses elicits action potentials in the A-alpha fibers at the beginning of the stimulus pulse both at the cathode (cathodal stimulation) and simultaneously in a hypopolarized region surrounding the anode (anodal stimulation). When recording with a bipolar surface electrode on the "anodal side" of the stimulating electrode a stimulus of medium strength gives a double peak response of submaximal amplitude. The peak with long latency is generated by the cathode and the peak with short latency by the anode. With a strong stimulus and recording on the "anodal side" only the short latency peak (with a maximal amplitude) is recorded. With a weak stimulus only the long latency peak (with a submaximal or maximal amplitude) is seen. These findings have importance in standard neurography investigations since mistakes concerning the polarity of the stimulating electrode affect the calculation of latencies, nerve conduction velocities, F-responses and SEPs. A nerve action potential with dual peaks may also be mistaken as a sign of anomalous innervation or activation of nerve axon subpopulations.

Action Potentials↗
PubMed1988

A new metabolite of diclofenac sodium in human plasma.

1. Among the phenolic metabolites of diclofenac in human plasma, an unknown compound (metabolite VI) was detected by h.p.l.c. and g.c. methods. This was also found in baboon plasma. 2. Metabolite VI was identified as 3'-hydroxy-4'-methoxy diclofenac by mass and n.m.r. spectroscopic analysis. Comparison with synthetic reference compound confirmed its structure. 3. In plasma, metabolite VI persists much longer than do unchanged diclofenac and the other phenolic metabolites. In urine, metabolite VI and its conjugates are excreted in trace amounts only. 4. A synthetic sample of metabolite VI was shown to be virtually inactive in animal models of inflammation and pain.

Adult↗
PubMed1987

Further observations on the depression of group Ia facilitation of motoneurons by vibration in man.

Stimulation of low threshold afferents in the peroneal nerve causes a short latency facilitation of individual tibialis anterior motor units considered to be due to the composite Ia EPSP. This facilitation is depressed by vibration 20 to 128 Hz applied over the tibialis anterior. The depression occurs without any change in the firing rate of the motor unit or in the facilitation from cutaneous afferents and so is unlikely to be due to postsynaptic inhibition. The depression can occur with vibration frequencies as low as 40 Hz and is therefore unlikely to be due to occlusion in Ia afferents. There is no evidence that vibration alters the electrical threshold of large afferents. A similar facilitation of soleus motor units resulting from stimulation of low threshold afferents in the tibial nerve is depressed for up to 75 ms following a 40 ms burst of 50 Hz vibration applied to the tendon of the tibialis anterior. The burst of vibration itself did not facilitate soleus motor units so there is no evidence to suggest that the vibration spread to soleus spindles. Homosynaptic depression is, therefore, unlikely. These findings provide further evidence that presynaptic inhibition of Ia afferents occurs in man.

Action Potentials↗
PubMed1986

Biotransformation of oxaprotiline: isolation and identification of metabolites in urine of rat and dog.

The biotransformation of oxaprotiline has been investigated in rat and dog after oral administration of racemic 14C-labelled oxaprotiline X HCl. Rats excreted 28% dose in urine within 120 h and dogs 32% within 96 h. The metabolites were isolated by liquid chromatography and their structures elucidated by spectroscopic methods. In both species, oxaprotiline is extensively metabolized. Principal metabolic transformations are aromatic hydroxylations and formation of aromatic hydroxy-methoxy derivatives, N-demethylation, deamination and direct O-glucuronidation. Most of the primary metabolites formed by functionalization reactions occur in both free and glucuronidated form. In the rat, diastereoisomeric 3-hydroxy metabolites and the corresponding phenolic glucuronides are predominant. Products of deamination are minor, and products of direct O-glucuronidation are not detectable. In the dog, biotransformation is more complex. Major metabolites are diastereoisomeric 2- and 3-hydroxy compounds and the corresponding phenolic glucuronides. Oxidations in the side-chain and direct O-glucuronidation are minor metabolic pathways.

Animals↗
PubMed1986

The metabolism of 14C-oxcarbazepine in man.

The disposition of the new anti-epileptic agent oxcarbazepine (10,11-dihydro-10-oxo-5H-dibenz[b,f]azepine-5-carboxamide) has been studied in two healthy volunteers following an oral 400 mg dose of 14C-labelled drug. The dose was excreted almost completely in the urine (94.6 and 97.1%) within six days. Faecal excretion amounted to 4.3 and 1.9% of the dose in the two subjects. In the 0-6 days urine samples the biotransformation products have been isolated and identified. 10,11-Dihydro-10-hydroxycarbamazepine (GP 47,779) and its two diastereoisomeric O-glucuronides were found as main metabolites. Taken together, they accounted for 79% of urinary 14C. Unchanged oxcarbazepine, and its sulphate and glucuronide conjugates were isolated in smaller amounts only (13%). Other minor metabolites were the trans- and cis-isomers of 10,11-dihydro-10,11-dihydroxy-carbamazepine (approximately 4%), and a phenolic derivative of GP 47,779 (less than 1%). The biotransformation of oxcarbazepine proceeds mainly by reduction to GP 47,779, and subsequent conjugation with glucuronic acid. Reduction is stereospecific, favouring the S-configuration of GP 47,779. Direct conjugation of oxcarbazepine, in the enol form, is a minor pathway. Oxidative reactions are unimportant.

Biotransformation↗
PubMed1985

Indoxyl derivatives of drug metabolites.

Indoxyl derivatives were detected as minor products among the urinary metabolites of two trial drugs, a benzodiazepine (GP 55 129) and a benzophenone (CGP 11 952). Their structures were elucidated by NMR and mass spectroscopy. Presumably, metabolites containing potential aldehyde functions react spontaneously with endogenous indoxyl. Such derivatives have not hitherto been encountered in drug metabolism.

Animals↗
PubMed1979

Biotransformation of diclofenac sodium (Voltaren) in animals and in man. I. Isolation and identification of principal metabolites.

1. The anti-inflammatory agent diclofenac sodium (o-[(2,6-dichlorophenyl)amino]phenylacetic acid sodium salt) is extensively metabolized by rat, dog, baboon and man. The main metabolites were isolated from the urine of all species and from the bile of rat and dog and identified by spectroscopy. 2. Metabolism involves direct conjugation of the unchanged drug, or oxidation of the aromatic rings usually followed by conjugation. Sites of oxidation are either position 3' or 4' of the dichlorophenyl ring or, alternatively, position 5 of the phenyl ring attached to the acetic acid moiety. 3. In the urine of rat, baboon and man conjugates of the hydroxylated metabolites predominate, but the major metabolite in dog urine is the taurine conjugate of unchanged diclofenac. 4. In the bile of rat and dog, the main metabolite is the ester glucuroniade of unchanged diclofenac.

Animals↗
PubMed1979

Human urinary metabolites of 1-(tetrahydro-2-furanyl)-5-fluorouracil (ftoraful).

Two hydroxylated metabolites were isolated from the urine of a patient who had received ftorafur (5 g/sq m). These metabolites were identified by mass spectrometry and nuclear magnetic resonance spectroscopy as trans-3'- and cis-4'-hydroxyftorafur. The compounds were not converted to 4-fluorouracil when incubated in plasma, base (pH 9), or water. Because of their stability, it is unlikely that these metabolites are in vivo precursors of 5-fluorouracil. There are indications that less stable, unisolatable, hydroxylated ftorafur derivatives are intermediates in the conversion of ftorafur to 5-fluorouracil.

Chemical Phenomena↗