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W Schürmann

Publications and source records attributed to W Schürmann.

17 recordsLinked to original sources
PubMed1992

Effects of diltiazem on oxygen delivery and consumption after asphyxial cardiac arrest and resuscitation.

BACKGROUND AND METHODS: Calcium-channel blockers may attenuate vasospasm after transient ischemia and improve organ blood flow after resuscitation. Our aim was to assess the effect of diltiazem on systemic oxygen delivery and consumption, hemodynamics, electroencephalogram (EEG), and organ blood flow after restoration of spontaneous circulation. After a 3-min period of asphyxial cardiac arrest, 14 pigs (20 to 27 kg) were randomly allocated to treatment with either diltiazem (0.1 mg/kg bolus followed by an iv infusion of 0.025 mg/min/kg over 120 mins) or placebo, given at 5 mins after successful resuscitation. Organ blood flow was measured using tracer microspheres 120 mins after resumption of spontaneous circulation. RESULTS: Median systemic oxygen delivery index values at 30, 60, and 120 mins after restoration of spontaneous circulation were 18.2 mL/min/kg (range 14.8 to 20.7), 16.8 mL/min/kg (13.2 to 20.8), and 19.6 mL/min/kg (16.9 to 21.0), respectively, in the diltiazem group and 13.1 mL/min/kg (11.2 to 14.6), 11.9 mL/min/kg (10.3 to 13.3), and 14.7 mL/min/kg (11.4 to 17.2), respectively, in the control group (p less than .05 for all three comparisons). At the same points in time, median systemic oxygen consumption indices were 3.2 mL/min/kg (range 2.2 to 3.7), 2.1 mL/min/kg (1.9 to 3.0), and 2.6 mL/min/kg (1.8 to 3.8) in the diltiazem group and 2.8 mL/min/kg (2.1 to 4.0), 2.7 mL/min/kg (1.7 to 4.3), and 2.3 mL/min/kg (1.6 to 3.8) in the placebo group (NS). Diltiazem enhanced the postarrest recovery of EEG total power. Right and left cerebral blood flow 120 mins after restoration of spontaneous circulation was significantly (p less than .01) higher in the diltiazem group in comparison with the control group. CONCLUSIONS: Diltiazem causes an increase in systemic oxygen delivery index by promoting vasodilation, but it does not change systemic oxygen consumption index in comparison to placebo treatment. It may be that an impairment in local autoregulation and/or in oxidative metabolism at the cellular or subcellular level was the reason why diltiazem did not improve these derangements. The observed increase in cerebral blood flow and in EEG recovery may be beneficial to the brain after a period of asphyxia.

Acid-Base Equilibrium↗
PubMed1991

[Patient-controlled analgesia versus epidural analgesia using bupivacaine or morphine following major abdominal surgery. No difference in postoperative morbidity].

In 1987, Yeager et al. reported that intraoperative epidural anesthesia with local anesthetics and postoperative epidural analgesia with opiates diminished postoperative morbidity. In our first clinical trial on this topic, the better postoperative analgesia with epidural bupivacaine-fentanyl failed to improve the outcome after major abdominal operations over that obtained with parenteral piritramide. This randomized controlled investigation was designed to assess whether intraoperative epidural anesthesia with bupivacaine plus light general anesthesia and postoperative epidural analgesia with morphine would diminish the overall rate of postoperative complications after major abdominal operations compared with general anesthesia (without epidural) followed by patient controlled analgesia with morphine, and with intraoperative epidural anesthesia with bupivacaine and light general anesthesia followed by postoperative bupivacaine-morphine analgesia. METHODS. A total of 292 patients undergoing infrarenal aortic bypass operation, gastric resection, gastrectomy, duodenum-preserving pancreatic resection, Whipple's operation or cystectomy and neobladder formation were randomly divided into three groups: 1. PCA group (patient controlled analgesia, n = 107): patients were operated on under general anesthesia (midazolam, fentanyl, N2O/O2, if necessary with addition of halothane, enflurane or isoflurane; muscle relaxation with pancuronium bromide). Postoperative management consisted in patient-controlled analgesia with morphine (Prominject), bolus 2 mg, lock-out 5 min (recovery room, intensive care unit) or 15 min (surgical ward). 2. EBM group (epidural bupivacaine+morphine, n = 95): operation under light general anesthesia (midazolam, low-dose fentanyl, N2O/O2, pancuronium bromide). In addition, a mixture of bupivacaine (0.25%) and morphine (60 micrograms/ml) was infused (approximately 0.1 ml/kg.h) via an epidural catheter during and after the operation (approximately 72 h). 3. EM group (epidural morphine, n = 90): operation under the same kind of general-epidural anesthesia as in the EBM group. Postoperatively, epidural injection of morphine (0.05 mg/kg in 10 ml of saline) on request up to the 3rd postoperative day. Quality of analgesia (at rest and when patients coughed vigorously), strength of cough, and rate-pressure product were recorded at 8:00 h, 12:00 noon, 16:00 h and 20:00 h on the 1st, 2nd and 3rd postoperative days. Incidence and intensity of all postoperative complications (cardiovascular, pulmonary, renal and other organ failure, reoperations, major infection, sepsis, thromboembolism, metabolic and mental disturbances) were assessed from the day of operation until discharge or death (n = 10), respectively. RESULTS AND DISCUSSION. In the PCA and EM groups analgesia was equal but of slightly inferior quality compared with the EBM group. The ability to cough was best in the EBM group and significantly worse in the PCA and EM groups, with no difference between the last two. (ABSTRACT TRUNCATED AT 400 WORDS)

Abdomen↗
PubMed1989

A placebo-controlled comparison of the efficacy and tolerability of picumast dihydrochloride and terfenadine in patients with seasonal allergic rhinitis.

Of 99 evaluable patients with seasonal allergic rhinitis, 33, 35, and 31 were treated with picumast dihydrochloride (3,4-dimethyl-7-[4-(4-chlorbenzyl)piperazine-1-yl]propoxycoumar in dihydrochloride) 1 mg, terfenadine 60 mg, and placebo, respectively, twice daily for 3 weeks. After 7 days' treatment physicians' assessments of symptomatic improvement showed that the effects of the two active drugs were similar and significantly superior to those of placebo. Some further improvement occurred over the remainder of the study, with no significant differences in efficacy appearing between picumast dihydrochloride and terfenadine. After 2 and 3 weeks of treatment the efficacies of both picumast dihydrochloride and terfenadine were "very good/good" in over 90% of patients. The tolerability of all three treatments was classified as "very good" in 60% to 70% of patients. Physicians were prepared to represcribe the study medication in about 90% of patients given picumast dihydrochloride or terfenadine compared with 52% administered placebo. Similar assessments performed by the patients generally agreed with these results. Withdrawal due to lack of efficacy occurred in 13, 2 and 0 patients treated, respectively, with placebo, terfenadine, or picumast dihydrochloride. Few adverse effects were reported. It is concluded that picumast dihydrochloride offers a comparable alternative to terfenadine in the treatment of seasonal allergic rhinitis.

Adult↗
PubMed1989

[The effect of adrenaline and noradrenaline on the oxygen supply of the myocardium during cardiopulmonary resuscitation].

The effect of epinephrine and norepinephrine on myocardial oxygen delivery and consumption during cardiopulmonary resuscitation using open cardiac massage after a 5-min period of electrically induced ventricular fibrillation was studied in 21 pigs with a mean body weight of 21 kg. Norepinephrine, like epinephrine, is a sympathomimetic agent with marked alpha- and beta-1-sympathomimetic activity, but the degree of beta-2-stimulation is less marked than that obtained with epinephrine. After mechanical measurements over 3 min (compression rate = 60/min), 7 animals received 10 ml physiological saline, 7 further animals, 45 micrograms/kg epinephrine, and the remaining 7 animals, 45 micrograms/kg norepinephrine. At 90 s and again at 5 min after the administration of epinephrine or norepinephrine, the mean arterial blood pressure was significantly higher than in the control group, while mean pulmonary artery pressure, central venous pressure and cardiac index were not significantly different. Total myocardial blood flow was only measured before the induction of cardiac arrest in the control group, where it was found be 193 +/- 30 ml/min/100 g. During the open cardiac massage but before the injection of catecholamines we found a myocardial blood flow of 51 +/- 23 in the control group, 71 +/- 10 in the epinephrine group, and 74 +/- 11 ml/min/100 g in the norepinephrine group. At 90 s after the injection, blood flow increased by 78% to 126 +/- 18, with epinephrine and by 45%, to 107 +/- 30 ml/min/100 g tissue with norepinephrine. At 5 min after administration of these catecholamines significant differences from the control group were present.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

An experimental study on the epidemiology of enteroviruses: water and soap washing of poliovirus 1--contaminated hands, its effectiveness and kinetics.

As enteroviruses are mainly transmitted by the fecal-oral route, this study was initiated to investigate the nature of the binding of enteroviruses to human skin. Using poliovirus 1, Mahoney, we investigated the overall effectiveness of soap and water hand-washing of 1 and 5 min duration. The virus-skin interaction was studied by kinetic analysis of repeated serial washings. The following results were obtained: (1) Soap and water washing for 5 min reduced the number of infective particles on hands by 2-4 logs of ten. (2) Poliovirus binding to skin was essentially reversible. (3) Removal of virus followed a triexponential decline curve, suggesting loose, intermediate, and strong binding. (4) Washing agents more effective than soap were sand, aluminum hydroxide powder, and buffer alone, suggesting that friction was more important than emulsification. The results demonstrate the tenacity of poliovirus on skin, and offer a rationale for the epidemiology of enteroviruses on experimental grounds. From a practical point of view these results stress the need for an effective chemical hand disinfectant, particularly in hospitals.

Aluminum Hydroxide↗
PubMed1983

Two cases of coxsackie B2 infection in neonates: clinical, virological, and epidemiological aspects.

Two cases of neonatal coxsackie virus B2 infection are described. One infant presented with meningitis and enteritis, the other with rhinitis, meningoencephalitis, and enteritis. Both infants made good recoveries. The virus infection could also be demonstrated in all nonimmune family members, most of whom gave a history of recent mild febrile disease (pharyngitis, diarrhea). Enterovirus infections may be suspected in cases of neonatal meningitis or myocarditis associated with gastrointestinal signs, especially 1. when it is during the hot season July-October, 2. when there has been febrile illness in other family members recently. For an effective and rapid isolation of the agent, rectal swabs or stool specimens not only from the patient, but also from household contacts should be sent to the virus laboratory on several consecutive days. Meningitic infection may be proved by an early c.s.f. sample. For serodiagnosis a first blood specimen should be drawn as soon as possible, a second one some days later. The importance of rapid virological diagnosis and of stringent hygienic measures to prevent spread of the infection is stressed.

Coxsackievirus Infections↗
PubMed1983

Problems of live virus vaccine-associated poliomyelitis a paralytic case with isolation of all three poliovirus types.

The case of a 4-month-old girl is described who developed a paralytic polio-like syndrome 3 weeks after oral polio vaccination (OPV). All three poliovirus types could be isolated (9 days after onset of disease polio type 2, and 33 days after onset of disease types 1 and 3, respectively). In order to classify these isolates as Sabin (vaccine)-like (SL) or non-Sabin-like (non-SL), several markers were tested in three laboratories [intratypic serodifferentiation, reproductive capacity at supraoptimal temperature (RTC), Al(OH)3 gel elution assay, and oligonucleotide mapping]. The results of the marker determinations were not uniform, but--summarizing all data--it seems plausible to associate the disease with the OPV. The significance of marker determinations in proving a vaccine-induced poliomyelitis is discussed in the light of this clinical case. Some comments are made on poliovirus vaccination policy in developed countries.

Antibodies, Viral↗
PubMed1983

Antiviral activity of an alcoholic hand disinfectant. Comparison of the in vitro suspension test with in vivo experiments on hands, and on individual fingertips.

The inactivation of eleven viruses by a commercial alcoholic hand disinfectant ("Desderman') was tested by three different procedures, viz., in vitro in a standardized suspension test, in vivo on the entire surface of both hands, and in vivo on individual fingertips of a single volunteer. The test protocols were chosen such as to make results comparable. The influence of varying disinfectant/virus volume ratios, serum protein loads, and reaction temperatures was evaluated in vitro, and partly demonstrated in vivo. In some experiments, 5% formaldehyde was included as a reference disinfectant. The experiments support the prevailing concept, that enveloped viruses are considerably more susceptible to alcoholic disinfection than naked ones. Additionally, enveloped viruses were shown to be subject to more "spontaneous' decay on skin. The main result of the study appears to be that the in vitro model predicted a greater effectiveness of the disinfectant than was observed in vivo both in the "hand' test and the "finger' test, although some differences were noted between these tests. Reasons for the lesser in vivo inactivation may lie in the evaporation of the disinfectant with ensuing changes in disinfectant/virus volume ratio, effective temperature, and inactivation time, all shown to influence disinfection. Other mechanisms such as a "sheltering' effect of the skin may have also been operating. The results suggest that, at the present stand of knowledge, in vitro screening tests should be complemented by in vivo tests for the evaluation of antiviral hand disinfectants.

Alcohols↗
PubMed1982

Demonstration of rubella-specific IgM by serum ultracentrifugation on sucrose gradients: comparison of a vertical and a swinging bucket rotor.

The performances of a vertical and a swinging bucket rotor in the diagnosis of rubella-specific IgM were compared using two sets of predominantly low titre rubella IgM positive sera. Applying a number of subtle criteria, the vertical rotor was shown to separate IgM and IgG less well than the swinging bucket rotor. If the vertical rotor was loaded with pretreated sera with IgG content decreased severalfold, its performance was similar to that of the swinging bucket rotor with native serum. The findings are discussed from the aspect of the main indication of rubella IgM testing, and it was concluded that for the majority of cases the vertical rotor would not present an alternative to the swinging bucket rotor.

Antibodies, Viral↗
PubMed1981

[Interferon].

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Humans↗
PubMed1978

A membrane model of the human oral mucosa as derived from buccal absorption performance and physicochemical properties of the beta-blocking drugs atenolol and propranolol.

The buccal absorption characteristics and physicochemical properties of the beta-adrenoceptor blocking agents propranolol and atenolol have been investigated to evaluate their permeation properties across biological lipid membranes. The dissociation constants, solubilities of free base, and n-heptane partition coefficients show that propranolol in its unionized form is much more lipophilic than atenolol, both drugs being bases with a similar pKa. Buccal absorption was studied under conditions of varying drug concentration, contact time, and pH, and controlled through the use of a non-absorbable marker. The absorption findings are in general agreement with the pH-partition theory. A new compartmental diffusional model that includes membrane storage and a hypothetical "aqueous pH-buffering surfaces system" allowed a more exhaustive interpretation to be made. A method for the estimation of the intrinsic pH and buffer capacity of the postulated surface system from drug pH-absorption data and partition coefficients alone is described. With human oral mucosa the intrinsic pH was near 6.7, and the buffering capacity of the system (expressed as the ratio deltapH/deltapH eff) about 2.86. The method was validated using published absorption data from the rat small intestine. Absorption of unionized drug through pores is shown to be negligible in the buccal absorption situation. The time course of absorption suggests membrane storage of lipophilic compounds; the in vivo partition coefficient of unionized propranolol relative to the mucous membrane could be calculated for the peusdo-steady state of absorption, i.e. the partition equilibrium between mouth content and membrane, to be approximately 776; this value is of the same order as the in vitro partition coefficient for the erythrocyte/plasma system. The lipid biophase of the buccal membrane is estimated semiquantitatively to be of intermediate polarity (epsilon = 3-4).

Absorption↗