[Editorial. Specialized pain therapy].
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Analgesia↗
Biomedical subjects
A Kopf
Publications and source records attributed to A Kopf.
[Co-analgesics in the treatment of chronic pain].
Opioids do not yield adequate analgesic effects in at least one-third of all patients suffering from chronic pain. Nonetheless, in contrast to former opinion there is no type of pain that is principally resistant to opioids, which means that the individual patient's response to opioid administration has to be investigated to determine adequate treatment. Opioids fail most frequently in cases of neuropathic, osseous or sympathetically maintained pain. In these cases there is an indication for early use of co-analgesics. The analgesic potency of anticonvulsives and tricyclic antidepressants has been best documented. A differential indication of the large number of possible coanalgesics should be determined with the help of a detailed pain history focussing on the pain quality. Similar to the WHO analgesic ladder used in (tumor) pain therapy, co-analgesic therapy should only be supplemented by invasive therapeutic procedures after various combinations and alternative substances have proven fruitless. Experience shows that this is necessary only for a small number of patients.
Analgesics, Non-Narcotic↗
Chest ultrasound in diagnosis of pulmonary embolism in comparison to helical CT.
UNLABELLED: To many people die because of undiagnosed pulmonary embolism. Common pulmonary embolism is the most unexpected mortal event in necropsy, antemortem correctly diagnosed in 18-39%. The diagnostic value of chest ultrasound (CUS) has been investigated. METHODS: 117 (68 women, 49 men) patients with clinical suspicion of pulmonary embolism underwent chest sonography and spiral computed tomography (CT). Final diagnosis has been made by CT respective with echo-cardiography, venous duplex sonography and fibrin dimer tests. RESULTS: Finally, 70 patients suffered from pulmonary embolism. The chest sonograms showed averaged 1.5 x 2.8 cm (0.5-8.5) large triangular or rounded hypoechoic lesions, mean 2.6 pro patient, similar in form and size as in CT. Fresh reperfusionable infarcts were homogenous and hypoechoic. Older infarcts were well demarcated, mainly wedge shaped. A hyperechoic reflex in the center corresponds to the bronchiole: a sign of segmental involvement. The sensitivity of chest ultrasound was 94%, the specificity 87%, positive predictive value 92%, negative predictive value 91%, accuracy 91%. Overall 61 patients had PE in CT, in 47 (67%) cases a direct emboli detection was possible. 14 patients had peripheral lung consolidations without detectable emboli, but fibrin-dimer tests were positive in all cases, there was deep vein thrombosis diagnosed and they showed signs of PE in echocardiography. Spiral CT showed a sensitivity of 85%, a specificity and a positive predictive value of 100%, a negative predictive value of 83% and an accuracy of 92%. CONCLUSION: CUS can improve diagnosis of pulmonary embolism. Sonography also reveals small infarcts which remain undetected with other imaging procedure such as helical CT.
Adult↗
Spitz nevus: a case report.
The case of a 2-mm Spitz nevus is reported. We comment on the case and describe the skin-surface microscopy features.
Adult↗
The role of the biarticular agonist and cocontracting antagonist pair in isometric muscle fatigue.
Isometric knee extensions until exhaustion at 30%, 50%, and 70% of maximum voluntary contraction were performed by 18 healthy subjects. During muscle fatigue, surface electromyographic activity was recorded from the knee-extensors vastus lateralis, vastus medialis, and rectus femoris, and the coactive antagonistic biceps femoris. The electromyographic parameter median frequency (MF) served as a measure of fatigue. Coefficients of regression of the MF fatigue changes were analyzed statistically. MF fatigue occurred within the coactive biceps femoris and was significantly more pronounced than in the quadriceps. When the MF fatigue shifts of the coactive biceps femoris were compared with each of the three investigated parts of the quadriceps separately, MF fatigue shifts were similar in shape for the biarticular coactive biceps femoris and the biarticular rectus femoris, but differed significantly between the biceps femoris and the two monoarticular muscles, vastus medialis and vastus lateralis. As both the biarticular agonist and coactive antagonist muscles fatigued at a higher rate than the two monoarticular muscles, it seems likely that this biarticular agonist/antagonist pair determines the time to the limit of endurance.
Adult↗
[Peridural administration of lipophilic opioids].
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Analgesia, Epidural↗
[Clinical gait analysis--methods, limitations and possible applications].
Human gait is a complex and cyclic movement. Gait analysis of human walking can be done either without any technical support, or in combination with complex and expensive equipment. Modern gait analysis is based on the integration of multiple components to derive a complete analysis of gait. These methods may include observation, videotaping, electromyography, kinematics, kinetics and energetics. The results gained from these methods may then be used to determine the treatment course of a subject with gait abnormalities or to document the effects of therapeutical intervention. The purpose of this article is to provide an overview of the most common used methods in gait analysis. Emphasis will be placed on the type of information that can be derived from each component and how this information can be used clinically.
Electromyography↗
[Importance and physiologic nutritional requirement of the selenium trace element within the scope of parenteral nutrition (TPN)].
BASIS: Selenium-responsive clinical manifestations of selenium deficiency and elucidation of the biochemical and molecular biological basis of the essentiality of selenium give evidence for the biological importance of the trace element in human nutrition. CONCLUSION: The dietary parenteral selenium requirement can be calculated on the basis of the maximal gene expression of the selenoprotein plasma glutathione peroxidase (plGPx). In total parenteral nutrition a daily requirement of 0.01 mumol/kg body weight for adults and 0.025 mumol/kg body weight for children can be seen as adequate and safe.
Adult↗
Comparison of two insole materials using subjective parameters and pedobarography (pedar-system).
INTRODUCTION:: The objective of this trial was to investigate two commonly used insole materials prescribed for shock-absorption and cushioning concerning subjective and pedobarographic parameters. The design was prospective, controlled, randomized and single-blinded. MATERIAL AND METHODS:: A convenient sample of six healthy male adults without any history of leg or foot injury or pain wore -- in random order -- the custom-made insoles for one week. For both insoles the same base material (TEPEFON(R)) was used, insole 1 was covered with PLASTAZOTE(R) I, 3 mm, insole 2 with PPT, 3 mm. Both insoles had a metatarsal pad. After one week of wearing, in-shoe plantar pressures, measured at the same time of day and within the same type of indoor tennis shoes (sockliner removed), were obtained using the PEDAR-System(R) (Novel GmbH, Munich, Germany). Before each measurement the PEDAR-insoles were calibrated and the subject walked around for 5 minutes to get aquainted with the device. Three trials were performed for three different conditions and average values were determined: PEDAR-insole alone, with PLASTAZOTE(R) insole, with PPT(R) insole. Data were collected at self selected speed, gait velocity was determined using two optical switches on a 10 m walkway. Pressures were normalized to body weight. Main outcome parameters were 'Maximal Peak Pressure' (MPP) and 'Pressure Time Integral' (PTI). These parameters were determined for the whole footsole, medial and lateral heel, medial and lateral midfoot, medial, middle and lateral forefoot, hallux and toes II-V. Additionally the subjects filled in a questionnaire including: time wearing the insoles daily (in hours), sweating (visual analogue scale -- VAS), wearing comfort (VAS), perceived discomfort (location). Three months after the trial they were asked via telephone call whether they were still using the insoles. RESULTS:: 1. The overall MPP and PTI values did not differ significantly between the PEDAR-insole alone and the investigated inserts. There was a tendency for both insoles towards lower MPP and PTI values in all regions except for the toes, especially for the PPT(R) insole. 2. The questionaire showed a significantly higher wearing comfort for the PPT(R) insole in contrast to the PLASTAZOTE(R) insole, though all subjects sweated more with the PPT(R) material. Four of the six subjects experienced discomfort due to the metatarsal pad within the PLASTAZOTE(R) insole, only one within the PPT(R) insole. 3. None of the subjects continued to use the PLASTAZOTE(R) insole, but three continued to use the PPT(R) insoles. DISCUSSION:: Despite the significant differences in the subjective parameters, especially wearing comfort, no statistical significant difference for the overall MPP and PTI values between the PEDAR-insole alone and the investigated insoles or in between the insoles tested could be obtained. Yet there was a tendency for both insoles to lower MPP and PTI values in all regions except for the toes. This might be due to the thickness of the insoles and the reduced space within the toe box. The subjectively better tolerated PPT(R) insole tended to lower MPP and PTI more than the PLASTAZOTE(R) insole. CONCLUSION:: Wearing comfort and pedobarographic outcome measurements did not correlate significantly in this trial. Yet there was a tendency for the subjectively better tolerated PPT(R) insole to lower MPP and PTI more.
Journal Article↗
[Ultrasound diagnosis of rib and sternum fractures].
PURPOSE: Lesions of the thoracic skeleton can sometimes be a problem in radiological diagnosis. Aim of the study was to investigate the value of ultrasound in the diagnosis of thoracic trauma in clinical practice. METHOD: Patients with thoracic trauma and suspected rib or sternal fracture were entered in the study. The results of the thoracic x-ray including a special target film and thoracic sonography were compared. RESULTS: 103 patients took part in the study (32 women, 71 men, average age 54.3 years). In x-ray the diagnosis of rib fracture was certain in 27 patients (30%). In US 56 patients (58%) had definitive signs of rib fracture. Because of multiple fractures in the same patients the total number of radiologically found rib fractures was 49, whereas 101 fractures could be detected by sonography. Also minimal pleural effusions could be found in 31 patients (32%) sonographically, only 18 of them were seen in x-ray. Larger effusions in six patients (6%) with serial rib fractures and haematothorax could all be diagnosed in x-ray and also US. The seven patients with suspected sternum fracture showed clear fracture signs in x-ray as well as US. CONCLUSIONS: Rib fractures could be found about twice as often US than x-ray. There was no difference in the diagnosis of sternal fracture. Detection of fluids (local haematoma and pleural effusion) is better via US than by x-ray. Therapeutical consequences may follow a quick bed-side diagnosis by US in a patient who needs intensive care. Other aspects after detection of a rib fracture US apart from thoracic contusion are psychological effects for the patients (usually they can cope better with their pain), the importance in the interpretation of the duration of incapacity to work and the additional information provided by expert opinions.
Female↗
[Can pleurisy be detected with ultrasound?].
PURPOSE: It was the aim of this study to examine whether chest sonography is a useful method for diagnosing infective pleuritis. We assessed the pleural surface, the presence of subpleural consolidations and of pleural effusions. METHOD: 47 consecutive patients with the clinical diagnosis of pleuritis were examined by means of a 7 MHz linear transducer. We studied the pleural surface, the presence of subpleural consolidations and of pleural effusions. RESULTS: Pathologic findings could be seen in 43 patients (91%). The smooth echogenic pleural line was interrupted and was rough in appearance in 42 patients (89%). Subpleural consolidations from 0.2 to 2 cm in size were observed in 30 cases (63.8%). In 11 (23.4%) of these lesions, colour Doppler signals could be demonstrated. Pleural effusions were visible either as localised pleural effusions (24 patients, 51%) or as basal effusions (11 cases, 23.4%). Aspiration of pleural fluid was performed twice. In one case the diagnosis of tuberculosis could be proven by fast acid stain, in another patient a pleural empyema was drained successfully under ultrasound guidance. In 5 patients therapeutic consequences resulted from sonographic findings. CONCLUSION: We conclude that chest sonography is a sensitive and cost effective imaging method for the diagnosis of pleuritis. Aspiration of pleural fluid for further diagnostic or therapeutic procedures can be safely performed.
Adult↗
The actinic comedonal plaque.
A case of actinic comedonal plaque is reported. We comment on the case as well as describe the skin surface microscopic features.
Acne Vulgaris↗
Surface boundary conditions for the Ginzburg-Landau theory of d-wave superconductors.
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Journal Article↗
Patient controlled oral analgesia with morphine.
PURPOSE: When using strong oral opioids for postoperative pain management, demand titration is desirable. A device for patient controlled oral analgesia (PCORA) and first results of its use for oral titration of morphine are presented. METHODS: The PCORA-device is a modified Baxter-PCA-on-demand system (maximum bolus volume: 0.5 ml; flow rate for filling bolus volume: 0.5 ml.hr-1). The demand PCORA-volumes were measured at specific time intervals and PCORA was compared with customarily prescribed pain therapy (CPPT) for postoperative pain management. On the first postoperative day, 20 orthopaedic ASA I or II patients received, in a randomised, cross-over trial, either PCORA (300 min) followed by CPPT (300 min) (Group I) or vice versa (Group II). The PCORA-device permitted a maximum dose of 15 mg morphine per 60 min and CPPT was performed by the ward doctor or nurse. Pain intensity (101-point numerical rating scale) and side effects were evaluated at 30 min intervals. RESULTS: The accuracy of the bolus volume delivered by the PCORA-device was 89.2 +/- 0.85% (mean +/- SEM), of manufacturer's specifications. PCORA pain intensity decreased over time whereas CPPT pain intensity did not (P < 0.001). PCORA-morphine requirements were 61.5 +/- 5.2 mg (Group I) and 52.5 +/- 8.5 mg (Group II) (NS; mean +/- SEM). The handling of the PCORA-device presented no problem to any patient. CONCLUSION: Patient controlled oral analgesia is an effective and non-invasive mode of postoperative pain management. The PCORA-device is reliable and easy to use.
Administration, Oral↗
[Difficult patients in the sleep laboratory--nCPAP therapy in psychiatric patients with sleep apnea disorders].
160 unselected patients under suspicion of sleep apnea were examined polysomnographically, 26 patients (16%) had relevant psychic disorders, which were classified according to ICD-10 by the psychiatric consultant. Affective-depressive disorders (n = 12) and neurotic disorders (n = 11) were diagnosed. Depression in 3 patients was primarily diagnosed in the sleep laboratory. A proper anamnesis can supply the doctor with helpful hints for psychic disorders. These disorders can complicate or prevent the diagnosis and therapy in the sleep laboratory.
Adult↗
[Nutrition physiologic significance of the trace element selenium within the scope of parenteral nutrition therapy].
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Critical Care↗
Ultrasound imaging of pneumonia.
One hundred forty-three consecutive patients with clinically and radiologically confirmed pneumonia were examined by ultrasound. In 127 cases (88.8%), a consolidation could be visualised in the sonogram. Eight patients (5.6%) had a pleural effusion only. The remaining eight (5.6%) had no pathological findings. The characteristic features of pneumonia were a hypoechoic consolidation with numerous small hyperechoic structures (112 patients, 88.1%) and a blurred margin. In eight cases abscess formation could be detected and treated by ultrasound-guided drainage. We conclude that sonography can visualise pneumonic consolidations in a high percentage, and gives additional information concerning the diagnosis, follow-up and treatment of pneumonia.
Adolescent↗