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Biomedical subjects

W Fabian

Publications and source records attributed to W Fabian.

At least 19 recordsLinked to original sources
PubMed1999

Pharmacotherapy of neurally mediated syncope.

A wide variety of pharmacological agents are currently used for prevention of recurrent neurally mediated syncope, especially the vasovagal faint. None, however, have unequivocally proven long-term effectiveness based on adequate randomized clinical trials. At the present time, beta-adrenergic receptor blockade, along with agents that increase central volume (eg, fludrocortisone, electrolyte-containing beverages), appear to be favored treatment options. The antiarrhythmic agent disopyramide and various serotonin reuptake blockers have also been reported to be beneficial. Finally, vasoconstrictor agents such as midodrine offer promise and remain the subject of clinical study. Ultimately, though, detailed study of the pathophysiology of these syncopal disorders and more aggressive pursuit of carefully designed placebo-controlled treatment studies are essential if pharmacological prevention of recurrent neurally mediated syncope is to be placed on a firm foundation.

Adrenergic beta-Antagonists↗
PubMed1998

Review article: heart rate and blood pressure control in vasovagal syncope.

Vasovagal syncope is characterized by transient failure of usually reliable physiologic mechanisms responsible for maintaining both systemic arterial pressure and cerebral blood flow. Two circulatory phenomena are almost universally present: systemic arterial vasodilation and bradycardia. A third phenomenon, cerebrovascular constriction, has also been described but its contribution to the faint is less well established. The neural reflex pathways responsible for triggering the circulatory changes in the vasovagal faint are incompletely understood, but have recently been the subject of renewed interest. In part, this interest probably stems from the frequency with which vasovagal symptoms are now recognized to be the cause of fainting spells. Additionally, however, there is an increasingly recognized need to develop treatment strategies for those affected patients in whom recurrent vasovagal symptoms are particularly troublesome. It is the goal of this discussion to focus on those aspects of circulatory control, and in particular on potential interactions among certain neural and humoral systems, which may contribute to the inappropriate physiologic responses associated with the vasovagal faint.

Afferent Pathways↗
PubMed1992

Pharmacokinetics of temafloxacin in patients with liver impairment.

A multicentre study was conducted to determine whether liver impairment would alter the pharmacokinetics of temafloxacin, a new fluoroquinolone antimicrobial agent. 16 patients with cirrhosis and 12 healthy volunteers (the control group) received a single oral 600mg dose of temafloxacin. Blood and urine were sampled at frequent intervals after drug administration and assayed by high performance liquid chromatography. The mean age of patients with liver impairment was greater than that of the control group; they also had a lower creatinine clearance and urine output. There was no difference between the groups in either the peak plasma temafloxacin concentration or the time to reach peak concentration. However, the volume of distribution and elimination rate constant of temafloxacin were significantly lower in the group with liver impairment, as were total temafloxacin clearance, renal clearance, and the ratio of renal:creatinine clearance. Nonrenal clearance was similar in patients and controls. Creatinine clearance and urine output were found to account for most of the intersubject variability in total clearance as determined by multiple linear regression analysis. Because the altered temafloxacin pharmacokinetics appear to be primarily due to impaired renal function, this should be the main determinant of temafloxacin dosage in patients with liver disease.

Adult↗
PubMed1992

Hepatobiliary elimination of temafloxacin.

The biliary excretion of temafloxacin and temafloxacin glucuronide was characterised in this study after administration of a single oral temafloxacin 600mg dose to 8 patients with T-tube drainage of the common bile duct inserted after cholecystectomy or choledochotomy. High performance liquid chromatographic analyses of plasma, urine and bile samples collected during the 72h after temafloxacin administration showed that biliary concentrations of unchanged temafloxacin followed a time-course parallel to plasma concentrations but were 5- to 10-fold higher. Biliary temafloxacin peak concentrations ranged from 18.74 to 64.35 mg/L and time to peak concentrations from 0.71 to 10.23h. Mean hepatobiliary clearance of temafloxacin was 3.10 ml/min (0.19 L/h) when calculated for the unchanged drug and 1.43 ml/min (0.09 L/h) when calculated for its biliary excretion as glucuronic acid conjugates. Patients with higher bile production had markedly higher clearance of both temafloxacin and temafloxacin glucuronide. The elimination time-course of the conjugate in bile generally paralleled those of temafloxacin in bile and plasma, although there was a lag in the rate of appearance of the conjugate in bile. Biliary excretion of unchanged temafloxacin and temafloxacin glucuronide accounted for approximately 2.2 and 1% of the administered dose, respectively. Thus, it appears that hepatobiliary elimination of temafloxacin and its glucuronide acid accounts for only a small fraction of total temafloxacin clearance. Nonetheless, concentrations attained in the bile are far above the minimum inhibitory concentration values of pathogens relevant in biliary tract infections.

Administration, Oral↗
PubMed1992

[Chilaiditi syndrome--general indications for surgical therapy?].

The usually asymptomatic Chilaiditi's syndrome is a rare anomaly which in most cases is detected accidentally by x-rays. We report two unusual cases with incarcerated interpositio coli hepato-diaphragmatica. Differential diagnosis and surgical management are discussed.

Abdomen, Acute↗
PubMed1991

[Missed traumatic diaphragmatic rupture--a legal insurance problem].

Even nowadays traumatic ruptures of the diaphragm cause diagnostic difficulties. Especially diaphragmatic ruptures of the so-called "late-type" are accompanied by uncharacteristic abdominal or cardio-respiratory complaints. These complaints depend on the type and the volume of the prolapsed organs. By hearing the classic previous history and symptoms the expert has to consider the diagnosis. Beside the previous history, the clinical evidents, the thoracic as well as the abdominal survey radiography, further informations can be given by Gastrointestinal passage with Gastrographin, by Colon contrast fluid enema and by abdominal CT. If there are no general contraindications, diaphragmatic ruptures have to be treated by surgery. There after patients are usually without complaints. Insurance-law-problems are unnecessarily created by "not identifying" fresh diaphragmatic ruptures and by "not considering" the possibility of "late-type" ruptures.

Adult↗
PubMed1991

[Caroli syndrome. Isolated congenital dilatation of intrahepatic bile ducts].

Caroli's disease is a rare, congenital autosomal-recessive condition in which the intrahepatic bile ducts show segmental cystic dilatation. In these saccular dilatations, calculi usually develop. often with subsequent cholangitis. The disease is discussed on the basis of a case, the diagnostic evaluation and treatment possibilities being discussed.

Adult↗
PubMed1991

[Primary mucinous carcinoma of the skin--diagnosis by exclusion].

We report on a young woman with primary mucinous carcinoma of the head. It should only be diagnosed after careful exclusion of metastases originating from other mucinous tumours. Local recurrence is often seen, even after wide surgical excision.

Adenocarcinoma, Mucinous↗
PubMed1991

[Hip para-articular fractures in patients over 100 years old].

Prompted by the rarity of successful treatments of patients more than 100 years of age, we report on two cases of fractures located near the hip joint. Both patients were operated urgently and discharged after a hospitalisation period of 5 and 6 weeks, respectively.

Aged↗
PubMed1991

[Early complications and their causes in prosthetic hip joint replacement for coxarthrosis or median femoral neck fracture. Retrospective study of 3613 implanted hip joints].

In this retrospective descriptive study--including 3613 patients--type, frequency, and causes of early postoperative complications after total hip replacement are analysed. Operations were indicated in the majority of all cases by degenerative hip-joint diseases (n = 3214) and 399 cases by medial collum femoris fracture from adduction type (Garden III and IV). The frequency of early postoperative complications in total amount to 14.3%, the postoperative mortality was 2.3%. Total hip replacement in medial collum femoris fracture showed a significantly higher frequency of postoperative complications (4 times) and mortality (17 times). Complications in detail (cardiac, pulmonic, thromboembolic, early luxation, wound infection etc.) are represented and discussed in literature.

Adult↗
PubMed1990

[Boerhaave syndrome].

The diagnosis, differential diagnosis and possibilities for treatment of Boerhaave's syndrome are discussed in detail on the basis of a case report. Suggestions for the early detection of this very rare, life-threatening disturbance, and thus for a decisive improvement in the prognosis of this condition, are made.

Aged↗
PubMed1990

[Efficacy of various treatment methods to extend the ischemia tolerance time of the liver. Experimental studies in dogs].

In a pilot-study (n = 66) and subsequent controlled experiment (n = 32) the ischemic tolerance of dog liver is examined by means of various clinical and laboratory parameters. During normothermia and without venous decompression the time of ischemic tolerance amounts to 60 minutes. Hypothermia and systemic administration of Aprotinin (Trasylol) and Methylprednisolone (Urbason) do not prolong the tolerance time of ischemia. This time is significantly extended by pre-operative administration of a thiourea-derivate (Propycil). Basing on this decisive improvement of the ischemic tolerance of dog liver, new advances in increasing the ischemic tolerance of human liver are offered.

Animals↗