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Biomedical subjects

W Funk

Publications and source records attributed to W Funk.

At least 19 recordsLinked to original sources
PubMed2006

[Acute hypertension following dexamethasone. A critical incident during anesthesia].

Prior to anesthesia a 65-year-old patient received 8 mg dexamethasone to prevent postoperative nausea and vomiting (PONV). Instantly she reported tingling and burning followed by intense pain in the genital region spreading to the whole body. Shortly later she complained about shortness of breath and pre-cordial pain. Acute hypertension could only be lowered by NTG, beta-blockade and induction of anesthesia. The ECG showed ST-segment depressions and troponin-T was elevated (0.3 ng/ml). Coronary angiography revealed no significant stenosis and an abdominal CT scan showed no evidence of a pheochromocytoma. Urine metabolites of catecholamines were negative. Thus, the most likely diagnosis was stimulation of endogenous catecholamines by painful stress after dexamethasone injection with the consequence of myocardial ischemia. As a result we now routinely inject dexamethasone after anesthesia induction as prophylaxis for PONV.

Aged↗
PubMed2000

[Brachial plexus. Long lasting neurological deficit following interscalene blockade of the brachial plexus].

An interscalene block of the brachial plexus was combined with general anaesthesia for repair of a complex chronic lesion of the shoulder. The localisation of the plexus with electro-stimulation and the injection of Bupivacain 0.5% were accomplished easily and without painful sensations. 48 hours later the block was still partially present. Paraesthesia and a sensory and motor innervation deficit affected mainly the dorsal fascicle, but also areas innervated by the median and lateral fascicles. The deficit did not completely disappear for 18 month. The cause could have been due to direct traumatisation during blockade or operation, toxic action of the injected substance (Bupivacain 0.5%, 30 ml), distension of the plexus, a cervical syndrome or an aseptic plexitis, although a definite determination is not possible. However, the pattern of the lesion and the lack of pain during localisation of the plexus and injection favour traumatisation during the acromioplasty.

Adult↗
PubMed2000

Oral preanaesthetic medication for children: double-blind randomized study of a combination of midazolam and ketamine vs midazolam or ketamine alone.

Anxiolysis and sedation with oral midazolam are common practice in paediatric anaesthesia. However, good or excellent results are seen in only 50-80% of cases. For this reason, we investigated if addition of a low dose of oral ketamine (MIKE: ketamine 3 mg kg-1, midazolam 0.5 mg kg-1) resulted in better premedication compared with oral midazolam 0.5 mg kg-1 or ketamine 6 mg kg-1 alone, in a prospective, randomized, double-blind study. We studied 120 children (mean age 5.7 (range 2-10) yr) undergoing surgery of more than 30 min duration. After oral premedication in the ward and transfer, the child's condition in the induction room was evaluated by assigning 1-4 points to the quality of anxiolysis, sedation, behaviour at separation from parent and during venepuncture (transfer score). On days 1 and 7 after operation, parents were interviewed for changes in behaviour (eating, sleep, dreams, toilet training), recollection and satisfaction, using a standardized questionnaire. The groups were similar in age, sex, weight, intervention and duration of anaesthesia. The transfer score was significantly better in the MIKE group (12.5 (95% confidence interval (CI) 11.9-13.1)) than in the ketamine or midazolam groups (10.6 (9.8-11.4) and 11.5 (10.7-12.3), respectively). Success rates for anxiolysis and behaviour at separation were greater than 90% with the combination, approximately 70% with midazolam and only 51% with ketamine alone. The incidence of salivation, excitation and psychotic symptoms was low in all groups. Vertigo and emesis before induction were significantly more frequent after ketamine premedication. During recovery, there were no differences in sedation or time of possible discharge. After 1 week, parents reported nightmares (ketamine five, midazolam three, MIKE one), restless sleep (five/four/four) or negative memories (three/four/one). There were no major or continuing disturbances in behaviour or development. In summary, significantly better anxiolysis and separation were observed with a combination of ketamine and midazolam, even in awake children (sedation was not successful according to the preset criteria), than with midazolam or ketamine alone. Duration of action and side effects of the combination were similar to those of midazolam. The combination of both drugs in strawberry flavoured glucose syrup (pH 4.5 approximately) is chemically stable for 8 weeks.

Anesthesia Recovery Period↗
PubMed2000

Anaesthesia for magnetic resonance imaging/computed tomography.

The need for general anaesthesia for magnetic resonance imaging/computed tomography investigations can be reduced by the implementation of structured sedation programmes supervised by anaesthetists. Despite its side-effects, chloral hydrate is still the drug most widely used. Rectal thiopental or intravenous propofol are suggested anaesthetic agents for pre-school children and uncooperative or claustrophobic individuals. Spiral computed tomography scans and ultrafast magnetic resonance imaging shorten immobilization times further. However, functional magnetic resonance imaging and intervention techniques in neuroradiology depend on a motionless patient. A useful strategy for testing anaesthesia equipment has been outlined.

Journal Article↗
PubMed1999

Senescence of the retinal pigment epithelium.

Senescence of human cells has largely been studied as an in vitro phenomenon resulting from replicative exhaustion. The literature contains many studies of retinal pigment epithelium (RPE) cells which document replicative senescence. Several studies by Burke and others illustrate the relationship between donor age and replicative lifespan, the relationship between geographical location of RPE in the posterior pole and replicative lifespan, and the phenomena of altered cellular morphology and decreased culture saturation density for senescent RPE cells. Other studies have focused on the alterations of the expression of specific genes or the alteration of enzymatic activities during the senescence of RPE cells in vitro. Recently, a technique utilizing a histochemical staining procedure for beta galactosidase has been developed which identifies senescent cells. Normal beta galactosidase histochemistry which identifies the lysosomal form of the enzyme is performed at pH 4.0, while senescence-associated beta galactosidase activity is observed at pH 6.0 and is observed in the cytoplasm. We have studied the replicative senescence of human RPE cells in vitro using this procedure and have also measured the length of chromosomal telomeres to identify the aging of cultures in vitro. Our results show that RPE cultures accumulate beta galactosidase positive cells as a function of the number of population doublings and that these data correlate with the shortening of chromosomal telomeres to a functional limit observed for many human cell types at senescence. We have also recently extended this work to the development of a senescence-associated beta galactosidase procedure for observing senescent RPE cells in vivo. Basically, the same histochemical procedure is used with a post-staining bleaching step to clearly visualize staining in the RPE. Our first studies were performed on globes from Rhesus monkeys at a variety of ages from 1 year to 29 years of age. The results show the accumulation of beta galactosidase positive cells in the older monkey eyes. We have also examined several human eyes in an attempt to observe whether any relationship exists between beta galactosidase staining and age, pathology (diabetes, basal laminar deposits), and geographical location (macula vrs. periphery). These studies represent a first effort to determine if senescent RPE are present in vivo. It will be important to extend these studies so that these data might be expressed on a quantitative bases.

Aging↗
PubMed1999

Dry soda lime markedly degrades sevoflurane during simulated inhalation induction.

We have investigated gas composition during simulated inhalation induction with sevoflurane to elucidate possible mechanisms of incidental prolonged induction times and airway irritation. Using a circle system, 8% sevoflurane in oxygen 6 litre min-1 was washed into an absorbing canister filled with fresh soda lime containing 2.9% KOH (Draegersorb, 'D') or no KOH (< 0.01%, Sofnolime, 'S'). The absorbent was dried by oxygen 20,000 litre before every second experiment. Maximum soda lime temperatures attained after 4-6 min were 107 degrees C using dry D and 62 degrees C (61 degrees C) with dry S. Temperature did not increase with fresh soda lime. With dry soda lime, sevoflurane was not detected at the T-piece for 3 min and reached 6-7% within 6-10 min. After 1 min, we detected methanol and compound A (CH2F-O-C(= CF2) (CF3)). Total amounts over 20 min were: methanol 1125 mg (D dry), 334 mg (S dry) and < 5 mg (fresh soda lime); compound A 148 mg (D dry), 13 mg (S dry) and 3-8 mg (fresh); and fluoride 8.5 mg (D dry), 3.3 mg (S dry) and 1 mg (fresh). Formaldehyde was detected only with dry lime (D > 2.5 mg, S > 0.6 mg). In summary, the use of moist soda lime is of crucial importance during inhalation induction. With dry soda lime, the patient may inhale potentially toxic degradation products in significant amounts. Sevoflurane degradation is aggravated by a high KOH content of the lime. The observed airway irritation may be caused by formic acid, which is generated in isomolar concentrations with methanol (Cannizzaro reaction). The amount of compound A found with dry KOH-containing lime is unlikely to be noxious.

Anesthesia, Closed-Circuit↗
PubMed1999

Compound A does not accumulate during closed circuit sevoflurane anaesthesia with the Physioflex.

We have investigated inspiratory and end-tidal gas composition during sevoflurane anaesthesia in a closed circle system with continuous gas flow (70 litre min-1, Physioflex) to determine possible accumulation of sevoflurane degradation products. During five abdominal operations in adults lasting more than 2 h, anaesthesia was maintained with an end-tidal concentration of 2% sevoflurane in 40% oxygen-air. The circle included an absorbing canister filled with 1 litre of fresh soda lime. Samples were obtained at the end of an expiration from the tracheal tube and from the inspiratory limb before, and at selected times after, addition of sevoflurane. The temperature of soda lime was 24.7 +/- 0.7 degrees C at the beginning and reached a maximum of 31.2 +/- 1.0 degrees C after 20-30 min, followed by a plateau. Inspiratory compound A (CH2F-O-C(= CF2)(CF3)) 3-8 ppm was detected after 10 min, but did not accumulate in the circle over 2 h without flushing. Expired concentrations were consistently lower with 1.5-3 ppm signalling absorption by patients. Calculated total amounts absorbed over 2 h varied between 2.0 and 7.2 ppm h. Other degradation products such as compound B or methanol were not detected. In summary, we did not detect sevoflurane metabolites with soda lime in significant amounts during closed circle anaesthesia with the Physioflex. The observed concentrations of compound A were below the threshold of nephrotoxicity in rats by a factor of more than 20.

Aged↗
PubMed1999

Elimination of methohexitone after long-term, high-dose infusion in patients with critically elevated intracranial pressure.

OBJECTIVE: To determine the plasma elimination of methohexitone in patients with critically elevated intracranial pressure (ICP) who received the drug in high doses for several days. DESIGN: Drug-monitoring study. SETTING: Intensive care unit at a university hospital. PATIENTS: Twelve intensive care unit patients with brain injuries who received methohexitone as a final therapeutic approach after routine therapy had proved to be insufficient in controlling critically elevated ICP. MEASUREMENTS AND MAIN RESULTS: Plasma samples were taken during methohexitone infusion, before cessation, and in distinct, short increments after discontinuation of the infusion. Methohexitone was determined in plasma by reverse-phase high-pressure liquid chromatography and photometric detection. The median duration of infusion of methohexitone was 137 hrs (minimum, 27 hrs; maximum, 445 hrs), with a median infusion rate of 62.5 microg/kg/min (minimum, 22.5 microg/kg/min; maximum, 116.2 microg/kg/min). Plasma concentrations of methohexitone at burst suppression under concomitant analgesic sedation ranged from 1.6 to 17.3 microg/mL (median, 4.7 microg/mL). After cessation of methohexitone infusion, the decline of plasma concentrations followed a biexponential function. Clearance rates, volume of distribution at steady state, context-sensitive half-time, and initial and terminal elimination half-times were calculated. Pharmacokinetic data showed remarkable interindividual variability that could not be correlated to the infusion rate, to the duration of the infusion, or to obvious differences in physiology or the disease states of these patients. Even in patients with high plasma concentrations who received the drug for a considerable length of time, the initial decline in plasma concentration was exponential, indicating redistribution. CONCLUSIONS: We conclude that the elimination kinetics of methohexitone after long-term, high-dose infusion in critically ill patients with brain injuries may favor the use of methohexitone over thiopentone for controlling critically elevated ICP by allowing for a more timely neurologic examination after cessation.

Adolescent↗
PubMed1998

[Patient-controlled analgesia. PCA in a three year old child after traumatic amputation].

We report the case of a 3-year-old boy, who received long-term parent-controlled analgesia after traumatic amputation of one leg. He underwent surgery 17 times for a period of 25 days. Parent-controlled analgesia was started four days after admission because analgesia with non-opioid analgetics (acetaminophen) proved to be insufficient. The pump was set to a bolus-dose of 23 micrograms kg-1 piritramide (dipidolor) and a lockout interval of 10 minutes. Permitted maximum cumulative dose in four hours was 5 mg piritramide. There was no continuous infusion of opioid. PCA and possible adverse effects were explained to the mother. A monitoring regimen was used to assess efficacy (pain intensity estimated by the mother), adverse effects (sedation score, occurrence of nausea and vomiting) and piritramide consumption. For fear of side effects opioid administration was insufficient in the beginning. After three days the mother used the PCA effectively and no additional analgesic medication was required. Nausea or other side effects were not observed. After seven days opioid consumption nearly doubled. Apart from tolerance, this might have resulted from the mother's caution in the first days. After 17 days the PCA was discontinued. Oral analgetics (tramadol) controlled the pain adequately. Management of postoperative pain in children is difficult and too often insufficient. PCA is a safe and effective method of providing postoperative pain relief. Feasibility was shown in adolescents and, more recently, in children aged five years and over. Only few reports are available describing long term use of PCA in children younger than five years. Our case suggests that PCA may also be used effectively and safely in children younger than five years, if experienced staff, a monitoring regimen and cooperative and well instructed parents are available.

Amputation, Traumatic↗
PubMed1998

[Biological monitoring during exposure to the anesthetics isoflurane and sevoflurane].

Exposure to traces of inhaled anaesthetic agents may impair the health of the operating theatre personnel. Although no cause-effect relationship has been found, most public health authorities recommend various occupational exposure standards to minimize possible health risks. If metabolites of the substances are known, biological monitoring is an alternative to the monitoring of the operating theatre's air. The new anaesthetic agent Sevoflurane is considerably more transformed to fluoride than Isoflurane. Concerning fluoride there exist Biological Tolerance Values of 4.0-7.0 mg fluoride (F-) per gram creatinine (Crea). The aim of our study was to compare the fluoride excretion under the occupational exposure to sevoflurane and isoflurane. By the means of a direct-reading instrument trace concentrations of sevoflurane, isoflurane, and nitrous oxide were measured during 40 anaesthetic procedures. Urine samples were collected before (Z1) and after the workshift (Z2), and in the morning of the next day (Z3). The analysis was done by the means of an ionselective electrode. The personnel-related concentrations (median, range) were 0.50 (0.16-7.04) ppm isoflurance and 27.36 (5.87-467.10) ppm nitrous oxide, and 0.79 (0.15-1.95) ppm sevoflurane and 17.74 (2.45-84.20) ppm nitrous oxide. The resulting fluoride values presented at Z1, Z2, and Z3 as median (range) during exposure to isoflurane were 0.15 (0.11-0.53), 0.19 (0.11-0.53), 0.20 (0.11-0.31) mg F-/g Crea, and 0.15 (0.10-0.46), 0.22 (0.13-0.44), 0.23 (0.15-0.69) mg F-/g Crea during exposure to sevoflurance, respectively. The trace concentrations were clearly under 10 ppm for the volatile substances and 100 ppm for nitrous oxide. The values are comparable to data recorded under similar working conditions. The measured fluoride values were low and remained under the legal tolerance values. Under the described conditions potential health risks were low.

Air Pollution, Indoor↗
PubMed1997

[Anesthesia for magnetic resonance tomography in neonates, infants and young children].

INTRODUCTION: Since patient cooperation in neonates and infants up to 5 years is always reduced, deep sedation is usually recommended to obtain constant high-quality images during MRI. According to the widely accepted AAP Guidelines, deep sedation is not always distinguishable from general anesthesia, substantiating the demand for state-of-the-art anaesthesia. This is particularly true in this age group, where pharmacokinetics and pharmacodynamics show wide interindividual variation. In this review we outline the techniques required to provide safe and effective patient care in the unique MRI environment. CHOICE OF DRUGS AND PROCEDURE: From the viewpoint of induction time, half-life of action and success rate, we have found that inhalation anesthetics and propofol present clear advantages. Both offer rapid induction and emergence, allowing outpatient examinations in a tight schedule with a reliable sedation state. Tracheal intubation or a laryngeal mask airway is required to supply volatile anesthetics and to secure the airway, since propofol in appropriate doses causes respiratory depression and loss of the protective reflexes. Positive-pressure ventilation is recommended since the reduction of tidal volumes by sedative drugs (including high-dose chloral hydrate, barbiturates) may cause atelectasis and decreased oxygen saturation. ANESTHESIA MACHINES: Several respirators work well outside a critical magnetic field strength of 10 mT (e.g. Draeger: Titus, Siemens: Servo 900). The use of long low-compliance tubing (4-5 m) allows the respirator to be placed at the distal end of the patient table. Sidestream capnometry and spirometry at the proximal tube connector facilitate compensation for losses in tidal volume due to gas compression. Syringe pumps work properly when kept outside the 10 mT line. Some defibrillators (e.g., Lifepac, Physiocontrol) are approved for use in strong magnetic fields. MONITORING: State-of-the-art monitoring is also attainable for high-risk patients, including invasive pressure measurement. Since wiring without special filters may not cross the HF shield of the examination room, hydraulic and pneumatic systems are used (blood pressure by oscillometry, airway monitoring by side-stream spirometry). Optical fibers are used for pulse oximetry. A telemetric EKG is usually provided by the MRT manufacturer. Because oscilloscopes are distorted by the magnetic field, the monitors are placed outside the examination room. In addition, this eliminates the possibility of erasing the EPROMs contained in most monitors. PERSONNEL: With the setup described, the presence of a second anesthetist within the examination room is superfluous. A second anesthesia team can shorten the time lag between examinations by overlapping induction if a separate anesthesia induction and emergence room is provided. CONCLUSION: The level of sedation required for MRI in newborn and infants can only be achieved safely and efficiently by general anesthesia performed by trained staff. Complete state-of-the-art anesthesia care can be delivered if appropriate instrumentation is used.

Anesthesia, General↗
PubMed1997

Laryngeal mask airway and uncuffed tracheal tubes are equally effective for low flow or closed system anaesthesia in children.

Low flow and closed system anaesthesia have considerable advantages in economy, limited atmospheric pollution, and maintenance of humidification and temperature. To benefit from these techniques leakage from the breathing system should be as low as possible. The sealing of the airway is crucial to ensure this. Therefore, we have investigated in 30 children, aged 2-6 yr, the effectiveness of the laryngeal mask airway (LMA) and the uncuffed tracheal tube (TT) for closed system paediatric anaesthesia, during positive pressure ventilation, in a prospective, randomized study. Ventilation was adequate in all cases with both devices. Loss of gas from the breathing system was less than 100 ml min-1 in 13 (87%) patients in the LMA and in 12 (80%) patients in the TT group, with a maximum of approximately 700 ml min-1 in the TT and approximately 350 ml min-1 in the LMA group. We conclude that the airway sealing with both devices was tight enough to perform low flow or closed system anaesthesia in paediatric patients aged 2-6 yr.

Anesthesia, Closed-Circuit↗
PubMed1997

Occupational exposure to sevoflurane, halothane and nitrous oxide during paediatric anaesthesia. Waste gas exposure during paediatric anaesthesia.

We report the findings of a study on exposure of operating room staff to sevoflurane, halothane and nitrous oxide during induction and maintenance of anaesthesia in children. Concentrations of anaesthetic agents in the operating theatre were measured directly by highly sensitive, photoacoustic infrared spectrometer during 20 anaesthetics. Samples were taken from the breathing zones of the anaesthetist and the circulating nurse. The operating theatre was of modern design with an air conditioning system providing 20 changes of air each hour. The threshold values of 100 ppm N2O, 50 ppm isoflurane and 10 ppm halothane recommended by the United Kingdom Committee for Occupational Safety and Health (COSH) were exceeded in several cases for a short time during mask induction. After tracheal intubation, trace concentrations of sevoflurane, halothane and N2O were mostly under the recommended levels and comparable to levels measured during adult anaesthesia.

Adult↗
PubMed1996

[Sevoflurane or halothane in inhalational anesthesia induction in childhood. Anesthesia quality and fluoride level].

UNLABELLED: Due to its low blood:gas partition coefficient (0.69) and its neutral odor, sevoflurane (S) is suitable for inhalational induction of anaesthesia. At the moment halothane (H) is preferentially used for this purpose due to its non-irritating odor and the smoothness of anaesthetic action. However, experience is limited with the use of S in children, and concern exists about potential renal toxicity of its metabolite, i.e. fluoride. Therefore, we compared S and H in an open, randomized phase III trial. MATERIAL AND METHODS: With approval of the ethics committee and written informed parental consent, 40 children (age 1-10, mean 5.3 years, ASA class I and II) had anaesthesia induced without premedication (fresh gas flow 6 l/min, N2O/O2 = 65/35). Concentration of volatile anaesthetics was increased every 3-5 breaths (S: 0.8...3.2 vol%, H: 0.4...1.6 Vol%). The ciliary reflex was tested until it disappeared. Airway reflexes and excitation were quantified using a score. Upon venipuncture, relaxation and intubation, anaesthesia was maintained with S (Fi: 2.4 vol%) or H (Fi: 1.2 vol%) in N2O/O2 (3 l/min, etCO2 35-38 mm HG). Alfentanil was supplemented in repeated doses of 20 micrograms/kg. ECG, NIBP, SpO2, Fi and Fet of CO2 and volatile anaesthetics were continuously recorded. At the end of surgery anaesthetics were terminated abruptly and fresh gas flow was increased to 6 l/min O2. Time to the first purposeful movement was registered. Serum fluoride levels were determined immediately after venipuncture, at the end of surgery and 70 min later. Time to possible discharge from the PACU was quantified using a modified Aldrete score. Data were analysed with descriptive methods, Student's t-test or non-parametric tests as appropriate. RESULTS: Groups did not differ with respect to age, weight, sex, or type of surgery. Total dose of anaesthetics was 1.60 MACxh for S and 1.77 MACxh for H (p = 0.68). Table 6 shows the essential data. Mean arterial blood pressures and heart rate remained within +/- 20% of age-related normal values (Table 7). Mean serum fluoride level was 23.1 +/- 1.2 mumol/l at the end of surgery and decreased to 18.6 +/- 0.970 min later (Fig. 3). CONCLUSIONS: Sevoflurane is an alternative to halothane in pediatric inhalational anaesthesia, with a comparable, low incidence of airway irritation and smoothness of induction. Because of the significantly faster induction and recovery it seems superior to halothane. With the fluoride levels measured, an impairment of renal function is unlikely.

Anesthesia Recovery Period↗
PubMed1996

[Sevoflurane in pediatric anesthesia].

Sevoflurane may be an interesting substance for paediatric anaesthesia due to its combination of a very low blood-gas partition coefficient and non-pungency. This review discusses the status of sevoflurane in paediatric anaesthesia on the basis of studies published so far. The blood-gas partition coefficient of sevoflurane in children is 0.66, and hence markedly lower than those of isoflurane (1.25) and halothane (2.26) [15]. Induction of anaesthesia with sevoflurane/N2O is slightly shorter compared to halothane/N2O (Table 1) [4]. During induction of anaesthesia, sevoflurane/O2 is more often associated with excitement (35%) than sevoflurane/N2O (5%) and halothane/N2O (5%) [25]. Seizure-like movements in one case [1] and electrically generalised but clinically silent seizure activity in two cases [12] may raise the question of seizure-inducing effects of sevoflurane. However, up to now there is no clinical evidence of epileptogenic effects of sevoflurane. The MAC50 in neonates and infants 1-6 months of age is 3.3 vol% [14]; in infants 6-12 months and children 1-12 years of age it is 2.5 vol.% [14]. Sixty per cent N2O decreases the MAC50 of sevoflurane and desflurane by only 20%-25% [3, 14]. In contrast, 60% N2O decreases the MAC50 of halothane in children by 60% [16]. Thus, the MAC-reducing effect of N2O in children appears to be attenuated in the presence of less soluble inhalation anaesthetics. Sevoflurane has a similar low incidence of airway irritation as halothane and provides a smooth induction (Fig. 2) [4]. Haemodynamics during sevoflurane anaesthesia may be somewhat more stable compared to halothane. Serum fluoride levels increase rapidly when sevoflurane is administered, but decrease shortly after discontinuation [4]. Mean maximum levels reported are about 20 mumol/l and are of no concern for renal function. A study with mivacurium indicates more pronounced muscle relaxation by sevoflurane compared to halothane [9]. Sevoflurane may induce malignant hyperthermia. Emergence from sevoflurane anaesthesia is significantly more rapid than after halothane anaesthesia (Table 1); however, it is associated with more restlessness and agitation, probably due to the earlier perception of pain [4]. The incidence of postoperative nausea and vomiting after sevoflurane anaesthesia is comparable to that after halothane (Table 2). Sevoflurane may be a user-friendly alternative to halothane and is more preferred by children than halothane [32]. The status of sevoflurane in paediatric anaesthesia will depend on several factors: its own benefit/risk-ratio, a possible re-evaluation of the known risks of halothane and the financial limitations of the hospitals.

Anesthesia Recovery Period↗
PubMed1995

[Aging and cancer. An analysis of cancer mortality in Germany 1900 to 1990].

The unification of Germany rendered possible the comprehensive overall calculation and subsequent analysis of cancer mortality of an entire population of 60 to 80 million people over a period of 90 years. 1. The total mortality rates (all forms) in the various age groups are largely constant. The increase in absolute terms is a consequence of the changing age distribution in the German population resulting in a larger number of people in higher age groups. 2. The age-related constancy of total cancer mortality can be confirmed statistically via longitudinal and cross-sectional approaches focussing on changing subject groups per calendar year as well as in a diagonal manner using the same group of subjects per year of birth. 3. Each age group has its own characteristic and exponentially-at higher age-increase cancer mortality rate which is independent of influences by e.g. personal environment or "generation". 4. The constancy of total cancer mortality implies a change in the distribution of organ manifestations which equilibrates any increases or decreases. Available data on organ manifestation of cancer from the year 1950 on are the basis of this observation. 5. Age-related constancy of total cancer mortality is a basic principle of cancer epidemiology.

Adolescent↗
PubMed1995

Functional characterization and developmental regulation of mouse telomerase RNA.

Telomerase synthesizes telomeric DNA repeats onto chromosome ends de novo. The mouse telomerase RNA component was cloned and contained only 65 percent sequence identity with the human telomerase RNA. Alteration of the template region in vivo generated altered telomerase products. The shorter template regions of the mouse and other rodent telomerase RNAs could account for the shorter distribution of products (processivity) generated by the mouse enzyme relative to the human telomerase. Amounts of telomerase RNA increased in immortal cells derived from primary mouse fibroblasts. RNA was detected in all newborn mouse tissues tested but was decreased during postnatal development.

3T3 Cells↗