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Biomedical subjects

B Dirks

Publications and source records attributed to B Dirks.

At least 19 recordsLinked to original sources
PubMed1997

Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation.

BACKGROUND: Studies in animals have suggested that intravenous vasopressin is associated with better vital-organ perfusion and resuscitation rates than is epinephrine in the treatment of cardiac arrest. We did a randomised comparison of vasopressin with epinephrine in patients with ventricular fibrillation in out-of-hospital cardiac arrest. METHODS: 40 patients in ventricular fibrillation resistant to electrical defibrillation were prospectively and randomly assigned epinephrine (1 mg intravenously; n = 20) or vasopressin (40 U intravenously; n = 20) as primary drug therapy for cardiac arrest. The endpoints of this double blind study were successful resuscitation (hospital admission), survival for 24 h, survival to hospital discharge and neurological outcome (Glasgow coma scale). Analyses were by intention to treat. FINDINGS: Seven (35%) patients in the epinephrine group and 14 (70%) in the vasopressin group survived to hospital admission (p = 0.06). At 24 h, four (20%) epinephrine-treated patients and 12 (60%) vasopressin-treated patients were alive (p = 0.02). Three (15%) patients in the epinephrine group and eight (40%) in the vasopressin group survived to hospital discharge (p = 0.16). Neurological outcomes were similar (mean Glasgow coma score at hospital discharge 10.7 [SE 3.8] vs 11.7 [1.6], p = 0.78). INTERPRETATION: In this preliminary study, a significantly larger proportion of patients created with vasopressin than of those treated with epinephrine were resuscitated successfully from out-of-hospital ventricular fibrillation and survived for 24 h. Based upon these findings, larger multicentre studies of vasopressin in the treatment of cardiac arrest are needed.

Aged↗
PubMed1996

Active compression-decompression cardiopulmonary resuscitation--instructor and student manual for teaching and training. Part I: The workshop.

In an attempt to standardize the teaching and training of active compression-decompression cardiopulmonary resuscitation (ACD-CPR), a group of leading emergency physicians, cardiologists, anesthesiologists, paramedics and nurses with practical, theoretical, educational, and scientific experience in the subject met in June 1995. The group was called The International Working Group of Teaching and Training Active Compression-Decompression CPR. The group was 'born' as a result of the first International Conference of Active Compression-Decompression CPR held in Copenhagen in March 1995. The following paper describes the background, development and text of and ACD-CPR course manual for both students and instructors.

Cardiopulmonary Resuscitation↗
PubMed1996

[The Ulm emergency medicine training course. 1: Concept].

The course in emergency medicine was introduced by the German Federal Government to meet the requirements of the curriculum of the 4th year of medical education in 1992. The Department of Anaesthesiology of the University Hospital Ulm drew up a course consisting of one week of practical instructions (Table 3) for groups of 24 students, case presentation and accompanying lectures that cover the topics of emergency medicine (Table 2). The course is part of continuous education in emergency medicine. It starts with courses in "first aid" and "first medical attendance to emergencies" followed by the "course"in emergency medicine" and further training weeks on the "mobile intensive care unit (MICU)" during the "internship" as well as a course on emergency medicine for ambulance doctors and the training on he job by an emergency physician during residency (Table 1). The aim of the course is training competence (psychomotoric skills and clinical competence) for the primary care of life-threatening emergencies. The following educational methods were included in the concept: problem oriented learning, situation-oriented learning, learning by doing (cognitive apprenticeship).

Anesthesiology↗
PubMed1996

[The Ulm Emergency Training Course. 2: Realization and acceptance of the emergency medicine practicum].

The first part of this publication described the concept of the student course in emergency medicine at the University Hospital Ulm as part of a "vertical curriculum" of education in emergency medicine. METHODS. A training circuit (Fig. 1) was conceptualised using training manikins (i.e. BLS, intubation, megacode training, ATLS training), computer programmes (ECG-simulation) and other means of instruction to simulate twelve realistic situations. These practical skill sessions were linked with case presentation and lectures. Its topics were chosen depending on the prevalence, type and urgency. Separate guidelines for teachers and students were edited prior to the beginning of the course in 1994. RESULTS. Evaluation showed good acceptance by the students for most parts of the course except the ATLS skill station and CPR computer simulations (Table 5). The score of the national board examination (multiple-choice test) of the students from Ulm was nevertheless not better than the mean of all german examinees (72.1 to 71.7%). CONCLUSION. The concept of the course in emergency medicine is well accepted by our students. Results of the national examination were not improved, since the course aims at performance, skills and competence in emergency medicine and not at teaching factual knowledge that is measured by the MCQ examinations.

Attitude of Health Personnel↗
PubMed1995

Responses of neurons in ventrolateral orbital cortex to noxious visceral stimulation in the rat.

In pentobarbital-anesthetized rats, responses of single neurons in ventrolateral orbital cortex (VLO) to noxious visceral (colorectal distension, CRD) and cutaneous stimulation were recorded. Of 71 neurons identified on the basis of spontaneous activity, 44 responded to CRD. CRD caused inhibition of neuronal activity in 38, facilitation of activity in four and 'mixed' responses in two of these cells. Cutaneous receptive fields were identified in 31 CRD-responsive and 10 CRD-non-responsive neurons. Cutaneous receptive fields were large and bilateral. 25 CRD-responsive cells responded only to noxious cutaneous stimulation, six had wide dynamic range responses. Six CRD-non-responsive cells responded only to noxious stimuli, four had wide dynamic range responses. No VLO neuron responded only to innocuous stimuli. These data are consistent with involvement of VLO in visceral nociception, possibly in non-discriminative aspects of nociception.

Animals↗
PubMed1994

Characterization of responses of primary somatosensory cerebral cortex neurons to noxious visceral stimulation in the rat.

In pentobarbital-anesthetized rats, responses of single neurons in primary somatosensory cortex (SI) to graded noxious visceral (colorectal distention, CRD) and cutaneous stimulation were recorded. One-hundred fifteen SI neurons were identified on the basis of spontaneous activity, 66 of which responded to CRD. CRD resulted in facilitation of neuronal activity in 33% and inhibition of activity in 52% of these cells. Fifteen percent had mixed facilitated/inhibited responses to varying CRD pressures. Cutaneous receptive fields were identified in 71% of CRD-responsive neurons, with low-threshold or wide dynamic range responses in most cases. Nearly all cutaneous receptive fields were small contralateral sites. Responses to CRD were independent of neuronal depth within the cortex. These data support a role of primary somatosensory cerebral cortical neurons in visceral nociception.

Animals↗
PubMed1994

A novel, conserved gene of the rat that is developmentally regulated in the testis.

From a rat testis library three overlapping cDNA clones were isolated that represent a novel single-copy gene, designated Tegt. Two transcripts of 2.8 and 1.0 kb were found in each organ tested. The shorter transcript was highly abundant in adult testis. A similar expression pattern was found in the mouse. Analysis of rat RNA from different stages of spermatogenesis indicated that accumulation of the short transcript occurred mainly postmeiotically. The rat Tegt gene maps to Chromosome (Chr) 7, and its mouse homolog to Chr 15.

Aging↗
PubMed1993

[Management of the patient with craniocerebral injuries at the accident site and clinic admission].

Between January 1991 and December 1992, there were 686 rescue operations involving patients with craniocerebral trauma in the catchment area of Ulm. There were 376 patients who had to be graded as seriously injured according to the NACA classification. In 178 cases there was a severe craniocerebral trauma, and 131 of these patients were admitted to the traumatology department of the University of Ulm. The pattern of injuries was analysed; multiple injuries were found in 63 patients, with injuries to the extremities and the thorax being most-frequent. The primary preclinical treatment for patients with craniocerebral trauma is demonstrated; the indications for intubation and artificial respiration are discussed, and also the selection of drugs. Diagnostic procedures and immediate treatment must initially be directed at securing vital functions. Treatment of life-threatening haemorrhage has priority over neurosurgical diagnosis and therapy. The urgent indications for neurosurgical intervention are: space-occupying intracranial bleeding, open craniocerebral traumas, and space-occupying depressed fractures.

Brain Injuries↗
PubMed1992

Characterization of the endogenous reverse transcriptase reaction products of SIVagmTYO-7, a simian immunodeficiency virus isolated from an African green monkey.

The products of the endogenous reverse transcriptase reaction of SIVagmTYO-7 were characterized after the reaction conditions had been optimized. The major reaction product in the presence of actinomycin D and oligo(dT) was a DNA with a size of 300 bases. Without actinomycin D two additional reaction products with 600 or 700 bases appeared. The 300 base product was identified as the (-)strong-stop DNA, whereas the 700 base product is the (+)strong-stop DNA. The 600 base product appeared only after oligo(dT) priming. The (-)strong-stop DNA hybridized specifically with a 9 kb RNA found in virus particles and three RNA species of 1.8, 4.8 and 9 kb isolated from SIVagmTYO-7 infected cells.

Animals↗
PubMed1992

Adrenaline: relationship between infusion rate, plasma concentration, metabolic and haemodynamic effects in volunteers.

The present study investigated the relationship between supraphysiological plasma concentrations of adrenaline and the resulting haemodynamic and metabolic effects. Adrenaline was administered at five infusion rates (0.01-0.2 micrograms kg-1 min-1) in an escalating sequence to eight volunteers. The arterial plasma concentration of adrenaline increased from 53 +/- 44 to 4349 +/- 818 ng litre-1 during the highest infusion rate. Typical haemodynamic responses, such as increase in blood pressure and heart rate, were seen. The plasma concentrations of glucose and lactate increased from 5.2 +/- 0.4 to 13.7 +/- 1.3 mmol litre-1 and from 0.9 +/- 0.3 to 4.7 +/- 2.6 mmol litre-1, respectively, during the highest infusion rate without a significant increase in insulin concentration. Non-esterified fatty acids increased from 379 +/- 97 to 1114 +/- 331 mumol litre-1 during the 0.06 microgram kg-1 min-1 infusion rate. Adrenaline had no selective haemodynamic effect. If similar metabolic effects occur in patients during treatment with adrenaline or other sympathomimetics, they may further increase breakdown of energy stores in a situation of increased catabolism, and impair utilization of parenteral nutrition.

Adult↗
PubMed1991

[In vitro drug interactions and their importance in anesthesiologic practice].

The potential for in vitro drug interactions is great in anaesthesiology because of routine intravenous comedication. When the drug is applied directly into (via) the injection port of the cannula most of these interactions are overlooked, whereas others show no visible signs. Chemical interactions depend on pH changes, formation of insoluble salts, oxidation and reduction, complex formation, or hydrolysis. Physical interactions are caused by changing of solvent system polarity, salting out, emulsion cracking or sorption. Solving the problem requires information (1) and precautions in respect of the mode of application (2). (1) Anaesthesiologists should know the most frequent mechanisms. Glucose infusions cannot be considered as safe carrier solutions for admixtures. Pharmacological databases should offer as much information as possible on incompatibility. (2) Injections into a separate line or lumen with a sodium chloride infusion are safe. Admixture is recommended only if compatibility is known.

Anesthesiology↗