Search PubMed⌕ Search

Biomedical subjects

A Ernst

Publications and source records attributed to A Ernst.

137 records · Page 8Linked to original sources
PubMedDate not supplied

The out-of-hospital use of a domestic violence screen for assessing patient risk.

OBJECTIVES: To determine the following: 1) whether a Domestic Violence Scene Assessment Screen (DVSAS) is accurate at predicting domestic violence (DV) when compared with results on the validated Abuse Assessment Screen (AAS), and 2) whether EMTs can perform accurately on a DVSAS after they have finished a transport so as not to interfere with routine care. METHODS: All patients transported by ambulance from domestic environments (i.e., home) by an urban EMS system were included in the study. A ten-question screen was developed to assess whether a domestic environment had a high risk of having DV (DVSAS). A positive answer to any of the questions was considered to be a positive result on the screen. A trained observer with no clinical duties rode on the ambulance for randomized shifts during a two-month period. The observer completed the DVSAS while at the scene, then the patient, if able, completed the AAS. After finishing the transport, the EMT completed the DVSAS based on his or her memory of the scene. Results of the observer DVSAS were compared with the results of the EMT DVSAS and with the AAS. RESULTS: A total of 43 transports from domestic scenes were included in the study. The observer DVSAS alone was positive in five cases (12%), the EMT DVSAS alone was positive in five cases (12%), and both were positive in seven cases (17%). Agreement between the EMT and the observer yielded a kappa of 0.56 adjusted for chance. Of 15 (42%) patients able to complete the AAS, one (7%) was positive on the AAS alone, four (27%) were positive on the observer DVSAS alone, and three (29%) were positive on both. The observer DVSAS agreed with the AAS results in ten of 15 (66%) of cases. When compared with the AAS, the observer DVSAS had a sensitivity of 75%, specificity of 55%, positive predictive value of 38%, and negative predictive value of 86%. CONCLUSION: Emergency medical technicians can complete the DVSAS at the end of a transport with good agreement with results obtained by an independent observer at the scene. The DVSAS is able to reflect the results of the AAS with moderate to good agreement.

Ambulances↗
PubMedDate not supplied

Autofluorescence bronchoscopy--a comparison of two systems (LIFE and D-Light).

BACKGROUND: Autofluorescense (AF) bronchoscopy is an established method to detect dysplasia and carcinoma in situ (CIS). Several different systems are currently available. OBJECTIVES: This study aimed to directly compare the LIFE system (Xillix Technologies, Vancouver, Canada) and the D-light system (Storz, Tuttlingen, Germany). METHODS: In a prospective study performed between May 1999 and October 2000, we examined patients with risk factors for lung cancer that underwent bronchoscopy with both (LIFE and D-light) systems in a crossover design. The findings were classified into normal, abnormal and suspicious lesions by independent investigators and then compared. RESULTS: This study comprised 332 patients (220 males, 112 females, mean age 62.7 years, range 40-85); 1,117 biopsies were studied (mean biopsy rate 3.4/patient). In 817 biopsies, mucosal areas were classified as normal with respect to control biopsy specimens, 113 as abnormal and 187 as suspicious using AF bronchoscopy. The histological examination showed normal tissue in 850 cases, in 55 cases scarring or inflammation, in 62 meta- or dysplasias, in 11 carcinomas in situ and in 127 invasive tumors. In only 5 cases, classifications were found to be different between the two systems (2 normal, 2 dysplasias, 1 invasive tumor). The mean time for the LIFE system examination amounted to 11.7 min (range 6.2-19.5) and for the D-light system to 7.4 min (range 4.3-11.9). This difference was statistically significant (p < 0.001). CONCLUSION: Both systems yielded comparable results. The examination time was significantly shorter with the D-light system, which may be explained by the more comfortable handling and the direct switch between white light and AF imaging. Different trials using either methodology could be compared directly.

Adult↗
PubMedDate not supplied

Cochlear implantation after acoustic tumour resection in neurofibromatosis type 2: impact of intra- and postoperative neural response telemetry monitoring.

The present paper reports about a 16-year-old male with neurofibromatosis type 2 (NF-2) of the Wishart type with bilateral deafness who had undergone cochlear implantation after resection of the acoustic neuroma (AN) of the same side. Neural response telemetry (NRT) recordings are essential in those patients during cochlear implantation where no stapedial reflexes can be electrically elicited due to the resection of the AN. In the present case, amplitude growth function and a type II pattern of the NRT waveforms could be well established. The comparison of the N(1) response intra-operatively and after 2 years showed a decline in latency by 50% and an increase in absolute amplitude by 10 times at the same current level of electrical stimulation. This improved auditory nerve transduction suggested a change to a 'faster' encoding strategy to improve speech understanding. The change from SPEAK to ACE 18 months after the operation led to an increase in the open-set sentence recognition test from 52 to 88%. Thus, NRT recordings monitor the intra-operative success of electrode placement and help to assess the integrity of the auditory pathway. Moreover, they can reliably be used in programming the speech processor postoperatively as objective tool. In patients with NF-2, the restoration of hearing can be successfully achieved in several ways. The indications for hearing implants (auditory brain stem and cochlear implants) should be carefully considered with respect to the remaining, functional integrity of the auditory nerve and the technical possibilities to monitor the success of these procedures.

Action Potentials↗
PubMedDate not supplied

The metabolic reaction of the cochlea to unphysiological noise exposure.

Guinea pigs were exposed to continuous white noise of 120 dB SPL. The performance included a recording of CM, pO2, and metabolites in the perfusate of the perilymphatic spaces. The metabolic reactions observed following the exposure are limited. No evidence of an overstimulation or of an insufficiency of the energy metabolism in the cochlea could be found. The results suggest the metabolic processes to be secondary to the sound-dependent damage of the organ of Corti after irreversible mechanical destructions in the hair cells.

Animals↗
PubMedDate not supplied

The effects of locally applied PAF in inner ear morphology.

The effect of a PAF-containing artificial perilymph (10(-7) M PAF) on the ultrastructure of the stria vascularis was investigated in acute perilymphatic perfusion experiments in guinea-pigs. We have shown previously that locally applied PAF at this concentration reversibly changes the endolymphatic potential (EP) (Ernst et al., 1989a) which suggests an interference with ion transport. Controls which were perfused with artificial perilymph as well as experimental animals were decapitated at 10, 30 and 60 min after starting the perfusion. Subsequently, the cochleae were removed and evaluated by electron microscopy. The histological findings do not correspond to those obtained with different substances modifying ion transport in the stria vascularis, e.g., ouabain, loop diuretics. There are only minor strial changes in our study. The relevance of PAF in cochlear physiology is discussed.

Animals↗
PubMedDate not supplied

Local effects of PAF in guinea-pig inner ear.

The effect of PAF-containing artificial perilymph at 10(-7) and 10(-8) M on the endocochlear potential (EP) was investigated in guinea-pigs. The inner ear was perfused and the EP recorded at the same time. The characteristic decline of the EP which is highly sensitive to all stimuli could be prevented by pretreating the animals with either ginkgolide B (BN 52,021) or BM 13,177 (Sulotraban). Less effective in preventing the EP decline was Daltroban (BM 13,505). The results are discussed with respect to an involvement of PAF in cochlear physiology and in the regulation of ion transport, respectively.

Animals↗
PubMedDate not supplied

[Oviductal physiological alterations and endosalpingiosis (author's transl)].

A study was made of the oviducts from 110 patients salpingectomized between 1943 and 1976, after endosalpingiosis had been diagnosed. All of the patients were infertile women in whom histopathology performed after surgery revealed diverticula located mainly in the isthmic and interstitial portions of the oviductal wall. By either continuity or invasion, these configurations spread the endosalpingeal epithelium into the peritoneum and/or the ovary. Endosalpingiosis affects the muscular layer of the oviduct, which becomes thickened and rigid, thus accounting for the severe alterations of tubal physiology. The clinical aspects and microscopy of endosalpingiosis are described, and their differences from those of adnexo-peritoneal endometriosis are discussed.

Adult↗