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Biomedical subjects

A Bauer

Publications and source records attributed to A Bauer.

At least 37 records · Page 2Linked to original sources
PubMed2004

Vasculitic purpura with antineutrophil cytoplasmic antibody-positive acute renal failure in a patient with Streptococcus bovis case and Neisseria subflava bacteremia and subacute endocarditis.

Subacute bacterial endocarditis is frequently associated with extracardiac manifestations and renal failure. Clinical variety of endocarditis manifestation is wide and has the potential to mimic vasculitis. Whereas Streptococcus bovis is often isolated and associated with colonic tumors, Neisseriaceae are rarely found. An association of subacute bacterial endocarditis and antineutrophil cytoplasmic antibodies has been described. We report on a 62-year-old man who was admitted to our hospital with acute oliguric renal failure and a nonpruritic purpural rush without fever. Antineutrophil cytoplasmic antibody diagnostic revealed perinuclear staining with a titre of 1 : 512 and antiproteinase-3 specificity. Immune complex-mediated glomerulonephritis without extracapillary proliferation was diagnosed in renal biopsy. Finally, blood cultures became positive for Streptococcus bovis and Neisseria flava. Echocardiography showed mobile vegetations on tricuspid valve. Under treatment with penicillin G and gentamicin, skin efflorescences and renal function recovered, but vegetations increased. A colonic tumor could be excluded, a disastrous dental status may have been a predisposal factor. When classical findings of subacute bacterial endocarditis are less clear, the presence of renal failure and antineutrophil cytoplasmic antibodies in absence of fever may lead to misdiagnosis and deleterious immunosuppressive therapy. Neisseria subflava, an upper respiratory tract commensal, may cause subacute bacterial endocarditis without typical symptoms.

Acute Kidney Injury↗
PubMed2003

Competence of mentally ill patients: a comparative empirical study.

BACKGROUND: This study investigates the competence of patients with dementia, depression and schizophrenia to make treatment decisions. The outcome of an objective test instrument is presented and compared with clinical assessment of competence by the attending physician. METHOD: The MacArthur Competence Assessment Tool-Treatment (MacCAT-T), a test instrument to assess abilities in different standards of competence, was administered to patients with diagnoses of dementia (N = 31), depression (N = 35) and schizophrenia (N = 43). Statistical significance of group differences in the MacCAT-T results were tested with the chi-square test. The concordance of the test and clinical assessment of competence by the attending physician were evaluated by Cohen's kappa coefficient. RESULTS: Patients with dementia, as a group, showed significantly more often impaired performance than those with schizophrenia who were still more impaired than depressed patients. Patients were classified as impaired or not depending on the standards used. By combination of all standards substantially more patients were classified as impaired than by clinical assessment (67.7 v. 48.4% of patients with dementia, 20.0 v. 2.9% of patients with depression, 53.5 v. 18.4% of patients with schizophrenia). CONCLUSIONS: Using different standards of competence the study showed substantial differences among patients with dementia, depression and schizophrenia. The high proportion of patients identified as incompetent raises several ethical questions, in particular, those referring to the selection of standards or the definition of cut-offs for incompetence. The discrepancy between clinical and formal evaluations points out the influence of the used procedure on competence judgements.

Adult↗
PubMed2003

Magneto-optical near-field microscopy of ultrathin films in ultrahigh vacuum.

We demonstrate that magnetic domains of ultrathin films can be imaged in situ in ultrahigh vacuum (UHV) by scanning near-field optical microscopy in combination with a Sagnac interferometer (Sagnac-SNOM). In the present set-up, the Sagnac interferometer is not only used for measuring the magneto-optical Kerr effect but also for tip-to-sample distance control. The high sensitivity of the instrument enabled us to study the magnetization reversal processes in externally applied magnetic fields in ultrathin films of Fe and Ni grown on Cu(100) single crystals.

Journal Article↗
PubMed2003

[Patients' perspective on the quality of informed consent into psychopharmacological treatment in schizophrenia and depression].

BACKGROUND: Respect for autonomy and the right to self-determination require informed consent of patients before any medical procedure. So far the majority of empirical studies on informed consent deal mainly with single aspects e. g. delivery and recall of information and legal questions from a physicians' perspective. In our study we examine the quality of informed consent to psychopharmacological treatment from the perspective of patients with schizophrenia and depression in a German university department of psychiatry. METHODS: Face to face interviews using a structured questionnaire by a research psychiatrist. The participants taking part in this study were inpatients diagnosed with schizophrenia and depression. All patients received medication for their condition. RESULTS: Half of the patients rated the information they received and the process of informed consent positive. Only a minority recalls information regarding the aim and the risks of the treatment. 20 % indicated that they have been informed about alternative treatment options. A quarter of the patients did not know that they had a right to refuse any treatment. CONCLUSION: Compared with studies including patients with somatic illnesses the participants in our study judge the process of informed consent rather critical. The results need to be discussed in the light of the special aspects of psychopharmacological treatment and different cultural and institutional settings.

Adolescent↗
PubMed2003

[Risk versus confidentiality: the therapist's responsibility for his psychiatric patient's acts].

In this article we deal with the responsibility and liability of the therapist for aggressive and criminal acts perpetuated by his psychiatric patient against third parties. This issue has been the object of controversial discussion among professionals in the legal and medical field since the famous case of Tarasoff (this psychiatric patient killed his former girlfriend after he informed his therapist of his intention to harm her. The therapist was sued because he did not warn nor protect the potential victim and did not prevent the criminal act). We describe the situation in the U.S. before Tarasoff and the implications of the decision of the Supreme Court of California in 1974-76 which dealt with this case and broadened the therapist's responsibility towards third parties. We also analyze the actual legal situation in Israel on this issue, its disadvantages and shortcomings. We suggest some proposals for improvement, together with some operational measures to cope with this complex issue including a thorough evaluation of the patient's clinical state, identification of the potential victim, warning and involvement of the relevant authorities, and hospitalization if needed.

Confidentiality↗
PubMed2002

Influence of different cuff inflation protocols on capillary filtration capacity in human calves -- a congestion plethysmography study.

It has been suggested that venous congestion plethysmography (VCP) substantially underestimates microvascular permeability by activation of a veni-arteriolar constrictor mechanism, even when using small (< 25 mmHg) congestion pressure steps. We studied human lower limbs of 18 young healthy volunteers to test whether the congestion pressure step size of the VCP protocol has an influence on the values of the capillary filtration capacity (CFC) and isovolumetric venous pressure (P(vi)). Two different dual stage VCP pressure step protocols, with 3 and 10 mmHg steps, were used in randomised order and separated by a transient reduction in congestion pressure. Since lymph flow is known to increase after venous congestion, we also looked to see if changes in the estimated lymph flow (J(v)L) occur as a result of these VCP protocols. The measured CFC (median [25th; 75th percentile]) was 2.6 [2.5; 3.2] x 10(-3) ml (100 ml)(-1) min(-1) mmHg(-1) with the 3 mmHg pressure step protocol, which was not different from the value of 2.9 [2.7; 3.4] x 10(-3) ml (100 ml)(-1) min(-1) mmHg(-1) obtained with 10 mmHg pressure steps. However, when either of these step sizes was applied after a transient venous decongestion, significantly higher values of CFC, 4.0 [3.4; 4.1] x 10(-3) and 3.5 [3.1; 4.5] x 10(-3) ml (100 ml)(-1) min(-1) mmHg(-1), respectively, were obtained (P < 0.05). The assessment of P(vi) was also independent of the pressure protocol (10 mmHg: 8.0 [5.7; 13.2] mmHg and 3 mmHg: 15.7 [12.5; 18.5] mmHg), but when P(vi) was measured after the transient deflation, significantly higher values were found with both 10 and 3 mmHg steps (24.1 [20.9; 27.3] and 30.4 [28.9; 30.9] mmHg, respectively; P < 0.01). The transient pressure reduction was associated with a rise in estimated J(v)L from 0.04 [0.03; 0.05] to 0.12 [0.08; 0.18] and 0.04 [0.04; 0.05] to 0.09 [0.07; 0.10] ml (100 ml)(-1) min(-1), respectively (P < 0.01). The first stage data from these protocols shows that the value of CFC is not influenced by the size of the cumulative venous pressure steps, providing they are of 10 mmHg or less. The data also show that J(v)L can be estimated with small step VCP protocols. We hypothesise that the sudden reduction in cuff pressure after venous congestion is associated with a temporary upregulation of lymph flow. As the congestion pressure is raised again, there is a modulation of the enhanced lymph flow, such that the resulting CFC slope appears greater than that obtained in the first stage of the protocol.

Adult↗
PubMed2002

[Informed consent and patient competence in the psychically ill. A review of empirical studies].

In clinical practice, patients' self-determination has become more and more important. However, in psychiatry, the practice of informed consent encompasses several problems. In many cases the psychiatrist is faced with the issue of determining patients' competence. This paper gives an overview of empirical studies on competence assessment in psychiatry. In the course of some of these studies, test instruments were developed which allow objective and reliable assessment of different standards of competence. The applicability of these tests is discussed. We present empirical data on the relationship between competence and psychopathologic symptoms and cognitive factors. In recent empirical research, a shift from an initial skepticism of the applicability of informed consent in psychiatry towards a more differentiated approach and an interest in multidisciplinary research can be observed.

Empirical Research↗
PubMed2002

Microvascular changes during anesthesia: sevoflurane compared with propofol.

BACKGROUND: We have developed a non-invasive computer-assisted venous congestion plethysmograph to measure the microvascular parameters in the lower limbs. This enables the assessment of microvascular changes following the induction of standardized anesthesia with either sevoflurane or propofol. METHODS: In a prospective randomized trial we measured the capillary filtration coefficient (CFC), isovolumetric venous pressure (Pvi), an index of the balance of Starling forces, and limb blood flow 24 h preoperatively, immediately after induction of anesthesia and on the 1st and 2nd postoperative day. Anesthesia was maintained with either 1.0% sevoflurane and 5 microg/kg/h remifentanil or propofol (3 mg/kg/h), and 5 microg/kg/h remifentanil in 20 female patients undergoing breast surgery. RESULTS: Preoperatively we found no significant differences between the mean CFC values of the sevoflurane group (3.7+/-0.3 ml/min 100 ml tissue/mmHg x 10-3=CFCU) and the propofol group (3.5+/-0.3 CFCU). In the sevoflurane group CFC decreased significantly to 2.9+/-0.2 CFCU, whereas it was unchanged in the propofol group. Both groups revealed a significant reduction in Pvi during steady-state anesthesia. Limb blood flow remained unchanged. There was an overall significant positive correlation between the perioperative fluid substitution and the difference between the preoperative and intraoperative CFC values (r = 0.64, P<0.01). CONCLUSION: The decreased CFC in response to sevoflurane may result in less extravasation of fluids into the interstitial space, thereby reducing intraoperative fluid requirements. These data suggest that sevoflurane may be the preferred anesthetic agent in subjects susceptible to large intraoperative fluid shifts.

Adult↗
PubMed2002

Metal insertion into NiFe-hydrogenases.

The synthesis and the insertion of the metallocentre of NiFe-hydrogenases is a complex process, in which seven maturation enzymes plus ATP, GTP and carbamoyl phosphate are involved. The review summarizes what is known about the properties and activities of these auxiliary proteins, and postulates a pathway along which maturation may take place.

Escherichia coli↗
PubMed2002

Comparison of B-mode and conventional colour/power Doppler ultrasound, contrast-enhanced Doppler ultrasound and spiral CT in the diagnosis of focal lesions of the liver: Results of a multicentre study.

AIM: In patients with lesions of the liver we compared diagnoses based on different methods of ultrasound as well as spiral CT with the final diagnosis reached at the time of the patient's discharge from hospital. METHOD: From records of a prospective multicentre study including 90 liver lesions investigated with B-mode baseline and conventional colour/power Doppler ultrasound, contrast-enhanced colour/power Doppler ultrasound and spiral-CT, we evaluated only those where diagnoses for all modalities were available, and where the diagnosis at discharge comprising all clinical, laboratory and imaging data as well as histologic proof was at least "highly probable". RESULTS: 60 lesions met the inclusion criteria. 20 lesions were ultimately diagnosed as benign, and 40 as malignant. With respect to the diagnosis of malignancy, sensitivity was 92.5 % (37/40) with B-mode and unenhanced conventional colour/power Doppler US ultrasound, 97.5 % (39/40) with contrast-enhanced colour/ power Doppler ultrasound, and 100 % with CT; the corresponding specificities were 65 % (13/20), 85 % (17/20) and 80 % (16/20). 4 of 7 false positive, and 2 of 3 false negative results in the unenhanced technique were diagnosed correctly with contrast-enhanced Doppler ultrasound. CONCLUSION: Compared to conventional ultrasound, contrast-enhanced Doppler ultrasound improved the diagnostic accuracy in 10 % of the cases. Its accuracy in our study was equal to that of CT.

Contrast Media↗
PubMed2002

Gizzerosine-induced histopathological lesions in broiler chicks.

1. The aim of this study was to investigate pathomorphological changes in broiler chicks fed with different doses of gizzerosine, a substance produced during the heat treatments of fish meal. 2. The experiment was carried out in Ross broiler chicks which were divided into three groups: group A received 100% of non-medicated commercial mash for broiler chicks. During an experimental 5-d period, 50% of commercial mash was replaced with unheated fish meal (0.65 ppm gizzerosine) in group B and in group C with heated fish meal (1.15 ppm gizzerosine). Fourteen chicks from each group were killed every day. Samples of gastrointestinal and lymphoid organs, lung, pancreas, liver, brain and kidney tissue were sampled for histopathological analysis. Organs were embedded in paraffin and stained with hematoxylin-eosin stain and using periodic acid-Schiff reagent (PAS) and Sudan III (frozen sections). 3. Necropsy did not reveal notable differences between treated groups. There were no significant histopathological changes in immunocompetent organs nor in the lungs, the pancreas, the kidney or the brain. Sharply demarcated multiple vacuoles were observed in the myocardium in group C toward the end of the experiment. In group C, the prevalent changes in the gizzard and the proventriculus were slight to severe cuticle erosions and oedema of the lamina propria with or without multiple vacuoles, respectively, towards the end of the experiment. The most prominent changes toward the end of the experiment were dispersed cell vacuolisation in duodenal, jejunual, ileal and caecal lamina propria in group C. 4. In conclusion, it should be emphasised that extra-gizzard gizzerosine-induced lesions are probably not mediated by H2-receptor stimulation, but could be a consequence of cellular hypoxia.

Animal Feed↗
PubMed2002

[The evaluation of mental capability to use firearms: practical and ethical questions].

UNLABELLED: This paper presents the results of a survey of 116 men who underwent psychiatric evaluation of their capacity to carry firearms. The data was collected using a standardized form. The results show the following profile: male, married with children, high school education and requesting the license to carry firearms due to reasons related to their type of work or their place of residence. The results point to several conclusions regarding the way in which these evaluations are performed. RECOMMENDATION: To centralize the process of evaluating the types of dangers within the auspices of one single medical institution.

Child↗
PubMed2002

Case report. Monascus purpureus--a new fungus of allergologic relevance.

Anaphylactic reactions to food containing allergens in the consumption or preparation of food are well known. However, allergy in the preparation of sausages has rarely been described. In the present study a 26-year-old-butcher was investigated who had a severe anaphylactic reaction developing sneezing, rhinitis, conjunctivitis, generalised pruritus, followed by widespread urticaria, Quincke's oedema and dyspnoe after starting to prepare sausages containing red yield rice. Red yield rice is produced by the fungus Monascus purpureus. It was the first time that Monascus purpureus could be shown as allergic agent by means of prick-to-prick test, Cellular Antigen Stimulation Test (CAST) and different immunoblots.

Adult↗
PubMed2002

Reflections on dangerousness and its prediction--a truly tantalizing task?

Risk or dangerousness is a problem which, of its very nature, must occupy the minds of all mental health and law enforcement professionals. Papers and research studies without number have attempted to define its extent and constituent elements and plumb the secrets of its assessment. Defining the tools and skills needed to analyze and predict dangerousness is a key contribution to helping psychiatrists and lawyers take their critical decisions on compulsory hospitalization, issuing or refusing a gun or driving license, etc. Members of other professions too have not only to decide whether or not to curtail an individual's civil rights but to be able to put forward rational and coherent grounds for their decision. And yet time after time mistaken decisions are made, frequently causing the subject of the decision unnecessary suffering and sometimes leading to a tragic outcome. The difficulty of risk assessment is its complexity, the result of a multitude of contributing and interacting variables. The 'dangerous person' does not have a single profile: there is no individual who under certain circumstances cannot become dangerous. That being so, the focus of our study must not be the factors capable of making a person violent but correctly managing the circumstances and situations in which violence can occur. For the purposes of this paper we concern ourselves only with the physical aspects of dangerousness. Although the risk we analyze here is bound up with an act of violence, we must keep in mind that dangerousness and violence are two separate concepts. After reviewing existing theory and current knowledge on risk assessment and prediction, we shall describe how the Israeli judicial and legislative systems deal with risk and attempt the task of forecasting the use of violence in a divided society in the throes of modernization. To close we propose an explorative study, designed to develop a short- and medium-range risk assessment instrument.

Cultural Characteristics↗