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Biomedical subjects

B Schmidt

Publications and source records attributed to B Schmidt.

At least 91 records · Page 5Linked to original sources
PubMed2001

[Gender-specific aspects in chronic low back pain rehabilitation].

Gender-specific Aspects in Chronic Low Back Pain Rehabilitation. Little is known about gender differences in utilisation, outcomes and evaluation of orthopaedic rehabilitation for chronic low back pain. The purpose of this article is to review and analyse the literature on rehabilitation and recovery of men and women with chronic back pain. In Western societies, chronic back pain is one of the most common causes for utilising medical rehabilitation services. In general no significant gender differences in the prevalences of back pain are found, but men are more sick-listed and early retired due to musculoskeletal diseases. Also, more men than women participate in medical rehabilitation programmes. National and international studies pinpoint the fact that differences exist between women and men with regard to participating in an orthopaedic rehabilitation programme. Additionally there is some evidence that different physical and psychological therapy services have different effects on health status of women and men. Mixed results are available regarding gender differences concerning the outcomes of rehabilitation programmes. Rehabilitation activities after discharge from in-patient programmes and these being performed within the home setting are primary indicators of recovery. Gender differences have been identified regarding various types of activities, apparently because especially family roles interfere with activity. Further research must be conducted so as to increase the understanding of women's and men's experiences relative to orthopaedic diseases and orthopaedic rehabilitation services.

Adult↗
PubMed2001

["Zest for life instead of strain of illness" - implementation and evaluation of a programme activating chronic back pain patients in a rehabilitation clinic].

"Zest for Life Instead of Strain of Illness" - Implementation and Evaluation of a Programme Activating Chronic Back Pain Patients in a Rehabilitation Clinic.A group training was developed for chronic back pain patients in a rehabilitation clinic to enhance coping, to activate internal and external resources, and to make transfer to everyday life easier. The training consists of 12 either physiotherapeutic or psychologically oriented sessions. The training was evaluated in a longitudinal, quasi-experimental control-group design. Patients of the intervention group (n = 144) and control group (n = 157) rated the usefulness of the rehabilitation for private and working life at the end of the in-patient phase (t1) and three month later (t2). They also evaluated selected elements of the rehabilitation (t2). Results show that the anticipated usefulness of the rehabilitation was rated higher at the end of the stay than three months later. This indicates frustration after returning to everyday life. Patients of the intervention group rated the transfer possibilities to working life higher than the control group. They also are more satisfied with the psychological parts of the rehabilitation. After minor revisions, such as strengthening the topic of employment, the training now is implemented in the clinic for all patients with chronic back pain.

Adaptation, Psychological↗
PubMed2001

[Fulminant acute retinal necrosis 10 months after ipsilateral herpes simplex virus encephalitis - a case report].

BACKGROUND: Cases of acute retinal necrosis caused by herpes simplex virus are rare. We present here a case with a very fast progression 10 months after a primary herpetic encephalitis in an immunocompetent patient. CASE REPORT: A 36-year-old otherwise healthy man presented in our hospital with an acute painless loss of vision on the left eye. Initial examination of the fundus showed peripheral retinal necrosis with intra- and preretinal haemorrhages and sheathing of retinal venules. Diagnosis was made by detection of viral DNA in vitreous fluid. Although an antiviral therapy with high doses of acyclovir was started, a vitrectomy with silicon oil instillation was necessary to stabilise the necrotic retina. CONCLUSION: Acute retinal necrosis is relatively rare, and fast diagnosis is required. A detailed case history with attention to previous infections with herpes simplex virus as well as clinical signs were the key for the diagnosis.

Adult↗
PubMed2001

Chorioamnionitis and inflammation of the fetal lung.

OBJECTIVE: Fetal intrauterine exposure to proinflammatory cytokines present in amniotic fluid has been associated with an increased risk of chronic lung disease. However, the impact of histologically confirmed chorioamnionitis on the fetal lung has not yet been elucidated. We therefore investigated cellular immune response, cell proliferation, and messenger ribonucleic acid cytokine expression in fetal pulmonary tissue in the presence or absence of chorioamnionitis. STUDY DESIGN: Serial tissue sections were obtained from 27 fetuses at the time of autopsy. Three mothers had received antibiotics for treatment of clinical chorioamnionitis before abortion. Immunohistochemical staining of lung tissue comprised lineage-specific markers (CD68(+), CD3(+), neutrophil elastase). Positively stained cells were evaluated with a graticule, and cells per 5 mm(2) were counted. We undertook in situ hybridization to assess the expression of interleukin 8 messenger ribonucleic acid in the fetal lung. RESULTS: Seven of 27 fetuses had been exposed to chorioamnionitis. Fetal lungs showed a marked increase in the presence of histologically confirmed chorioamnionitis in densities of CD68(+) macrophages (68 vs 9.5 cells/5 mm(2), median group vs control group; P =.02) and lymphocytes (7 vs 2.5 cells/5 mm(2), median chorioamnionitis vs control group; P =.05) and a similar but lesser increase in neutrophil density (16 vs 4 cells/5 mm(2); difference not significant). Interleukin 8 messenger ribonucleic acid was expressed in 4 of 6 tissue specimens investigated in the chorioamnionitis group. Exposure to chorioamnionitis resulted in interleukin 8 messenger ribonucleic acid expression 7-fold higher than in the nonchorioamnionitis group; however, this difference did not achieve statistical significance. CONCLUSION: Chorioamnionitis was associated with an intrauterine inflammatory response of the fetal lung characterized by a severe infiltration of macrophages, neutrophils, and lymphocytes and also by an increased expression of interleukin 8 messenger ribonucleic acid.

Antigens, CD↗
PubMed2001

Do we measure the right end points? A systematic review of primary outcomes in recent neonatal randomized clinical trials.

OBJECTIVES: We performed a systematic review of primary outcomes in recently published neonatal randomized clinical trials to determine what end points are chosen for the evaluation of therapies in newborn infants. METHODS: MEDLINE was searched in May 1998 for neonatal RCTs that had been published since 1993 in the British Medical Journal, The Journal of Pediatrics, Lancet, The New England Journal of Medicine, and Pediatrics. The primary outcome was identified wherever possible. Continuous measures were distinguished from discrete outcome events. The latter were classified as "long-term" if they were ascertained at least 6 months after birth. The hypothesized relative risk reduction for primary outcome event rates was calculated, where possible. RESULTS: Of 119 eligible reports, 91 had an identifiable primary outcome that was a continuous measure in 46 trials and a discrete event in 45 trials. The median relative risk reduction was 50% for 28 of 40 short-term trials and 40% for 3 of 5 long-term trials. CONCLUSIONS: Most authors of recently published neonatal RCTs in 5 high-profile journals either failed to specify a primary end point or chose a continuous outcome measure. Trials with a discrete primary outcome were often short-term and designed to detect large risk reductions. Therefore modest but important treatment effects were likely missed by many of these trials.

Data Interpretation, Statistical↗
PubMed2001

Transport risk index of physiologic stability: a practical system for assessing infant transport care.

OBJECTIVES: To develop and validate a practical, physiology-based system for assessment of infant transport care. STUDY DESIGN: Transport teams prospectively collected data, before and after transport, from 1723 infants at 8 neonatal intensive care units (NICUs) from 1996 to 1997. We used logistic regression to derive a prediction model for mortality within 7 days of NICU admission and develop the Transport Risk Index of Physiologic Stability (TRIPS). We validated TRIPS for prediction of 7-day mortality, total NICU mortality (until discharge), and severe (> or =grade 3) intraventricular hemorrhage. RESULTS: TRIPS comprises 4 empirically weighted items (temperature, blood pressure, respiratory status, and response to noxious stimuli). TRIPS discriminated 7-day NICU mortality and total NICU mortality from survival with receiver operating characteristic areas of 0.83 and 0.76, respectively. There was good calibration across the full range of TRIPS scores and gestational age groups. Increase and decrease in TRIPS scores after transport were associated with increased and decreased mortality, respectively. The receiver operating characteristic area for TRIPS prediction of severe intraventricular hemorrhage was 0.74. Addition of TRIPS improved performance of prediction models in which gestational age and baseline population risk variables were used. CONCLUSIONS: TRIPS is validated for infant transport assessment.

APACHE↗
PubMed2001

Eligibility for home treatment of deep vein thrombosis: a prospective study in 202 consecutive patients.

PURPOSE: Home treatment of deep vein thrombosis (DVT) has been shown to be safe and effective. However, this conclusion has been drawn from studies with predefined patient selection criteria. Eligibility for home treatment has never been properly assessed. METHODS: In a 9-month period, we prospectively evaluated the possible reasons for hospital treatment in consecutive patients with acute DVT by using a check list that included medical reasons, home care situation, preferences, and hospital service logistics. Treatment consisted of low-molecular-weight heparin and concomitant oral vitamin K antagonists and compression therapy. A 3-month follow-up examination included assessment of recurrent venous thromboembolism (VTE), bleeding events, and mortality. RESULTS: A total of 202 patients were included in the study; 117 patients (58%) were outpatients and 85 patients (42%) were hospitalized before DVT diagnosis. Of the 117 outpatients, 95 (81%) were considered eligible for home treatment. Only two patients (1.7%) were admitted to the hospital for DVT-related morbidity, one (0.85%) because of comorbidity, 11 (9.4%) for home care reasons, and eight (6.83%) because of hospital service logistics. Of the hospitalized patients, 79 (92.94%) remained inpatients, and six (7.05%) could be discharged within 48 hours. The only reason for hospitalization was pre-existing comorbidity. In outpatients, the outcome after 3 months showed a 4% rate of recurrent VTE, no major bleeding, and an 8% mortality rate; 75% of deaths were caused by cancer. No patient died of VTE. In inpatients, a statistically significant higher mortality rate was found (8% vs 19%; P < .02). CONCLUSION: Less than 3% of patients with DVT who were outpatients had to be hospitalized because of DVT morbidity. For the entire DVT population, the main reason for hospital treatment is comorbidity, rather than management issues or DVT morbidity.

Adult↗
PubMed2001

Rare indications for a Kausch-Whipple procedure.

OBJECTIVES: To find out whether the Kausch-Whipple operation is adequate for the cure of rare tumours of the pancreatic head. DESIGN: Retrospective study. SETTING: University hospital, Germany. PATIENTS: Of 640 patients who had Kausch-Whipple procedures between 1972 and 1998 we found 42 (6.6%) who were operated on for rare tumours of the pancreatic head. RESULTS: Among these 42 patients 12 had functioning and non-functioning endocrine tumours, 11 had adenomas that were not locally resectable, 6 had leiomyosarcomas or oncocytomas, 4 had cystadenocarcinomas, 3 had acinar cell carcinomas, 2 had primary lymphomas, and 3 had metastases to the pancreatic head. Operative treatment (such as extended resection), postoperative course, and survival time after operation varied. Patients with adenomas had the most favourable mean survival time of 106.5 months. Among patients with cancer, those with endocrine malignancies had the best outcome with a mean survival duration of 58.3 months.

Adult↗
PubMed2001

Quantification of the effect of inhaled budesonide on airway inflammation in intermittent asthma by bronchitis index.

The bronchitis index (BI) is a scoring system for the visual quantification of airway inflammation by flexible bronchoscopy. A prospective study was carried out to determine whether patients with intermittent asthma present a considerable visible airway inflammation. Ten steroid-naive patients with intermittent asthma taking only inhaled beta2-agonists were enrolled and received budesonide (800 microg/day) over a period of 4 weeks. The airway inflammation was assessed by flexible electronic videobronchoscopy before and after the steroid treatment phase and quantified using the BI. Despite normal pulmonary function, all patients with intermittent asthma showed a marked visible airway inflammation that was reversed by a 4-week treatment with the inhaled steroid budesonide. The present study demonstrates that the BI may be useful as a clinical research tool for the assessment and quantification of airway inflammation in asthma. Furthermore, our results support the widely recognized theory that airway inflammation is present even in patients with mild asthma, and emphasize the necessity of an early therapy with inhaled steroids.

Administration, Inhalation↗
PubMed2001

Therapy of isolated calf muscle vein thrombosis with low-molecular-weight heparin.

There are no data from prospective studies concerning the treatment of isolated calf muscle vein thrombosis (soleal and gastrocnemial muscle veins), found in 20-40% of patients with lower extremity thrombosis of the calf. We investigated the outcome in two cohorts of consecutive patients, the first receiving low-molecular-weight heparin for 10 days at therapeutic doses and compression therapy; the second cohort, compression therapy alone. In patients on therapeutic heparin (n = 52), no progression to deep vein thrombosis occurred [0%; 95% confidence interval (CI), 0-6.8%]. Patients without anticoagulation (n = 32) showed a statistically significant higher percentage of progression into the deep calf veins (25%; 95% CI, 11.5-43.4%) as well as recurrent muscle vein thrombosis. No symptomatic pulmonary embolism or bleeding event occurred; one patient died in each group, both related to malignancy. The data suggest a need for short-term anticoagulation in such patients to prevent further thromboembolic complications. Randomized prospective studies are now warranted in a larger study population.

Adolescent↗
PubMed2001

Cerebral phosphate metabolism in first-degree relatives of patients with schizophrenia.

OBJECTIVE: Most phosphorus-31 magnetic resonance spectroscopy ((31)P-MRS) studies have described measures of lower membrane anabolism or greater catabolism in the frontal lobes of patients with schizophrenia. The purpose of the present study was to evaluate whether these findings can also be detected in young subjects at genetic risk for schizophrenia. METHOD: Fourteen children and siblings of patients with schizophrenia (mean age=16.7 years) and 14 comparison subjects (mean age=16.9 years) were included in a (31)P-MRS study of the frontal lobe. RESULTS: The high-risk subjects had significantly lower mean ratios of phosphomonoesters to phosphodiesters (0.25 versus 0.31) and higher mean phosphodiester values (37.59% versus 34.87%) than comparison subjects. CONCLUSIONS: These findings suggest greater phospholipid breakdown even in young first-degree relatives of patients with schizophrenia. This suggestion is discussed with respect to the membrane phospholipid hypothesis of schizophrenia.

Adolescent↗
PubMed2001

Reliability of wound measuring techniques in an outpatient wound center.

Wound measurements determine whether treatment(s) should be continued or changed. A busy wound clinic must rely on many different personnel for wound measurements. The realization that using a variety of measurement techniques could effect medical treatment choices raised concerns. To determine the inter-rater reliability of wound measuring techniques used by clinical staff in an outpatient wound center, three approaches to wound measurement were studied with the intent to standardize clinic procedures in the authors' facilities and to use the method with greatest inter-rater reliability. An exploratory descriptive study was initiated in a busy multidisciplinary wound-healing clinic in a northeastern Ohio 500-bed teaching and community hospital. Participants included 16 wound care professionals who staff an outpatient wound center. Inter-rater reliability measures were compared to three measurement techniques. The intraclass correlation coefficient was used as the statistical measure of inter-observer agreement. After comparing measurements made by the usual method used by an individual, the clockwise method, and the perpendicular method, the perpendicular method showed clear superiority in agreement among clinicians (ICC .962; df = 11,143; P = < 0.001) as compared to the clock-wise method (ICC .682; df = 11,154; P = < 0.05). This study provided a basis for standardizing the approach to wound measurement among physicians and nursing personnel and has important implications for effective medical care, research, and healthcare cost savings.

Adult↗
PubMed2000

Endocytosis of insulin-like growth factor II by a mini-receptor based on repeat 11 of the mannose 6-phosphate/insulin-like growth factor II receptor.

The mannose 6-phosphate/insulin-like growth factor II receptor (M6P/IGF-II receptor) plays an important role in controlling the extracellular level of the insulin-like growth factor II (IGF-II) by mediating its binding at the cell surface and delivery to lysosomes. Loss of the receptor is associated with an accumulation of IGF-II, which can cause perinatal lethality if it is systemic, or local proliferation and tumorgenesis if it is spatially restricted. The extracytoplasmic domain of the receptor consists of 15 homologous repeats, of which repeat 11 carries the IGF-II-binding site of the multifunctional receptor. To investigate whether repeat 11 is sufficient to mediate binding and internalization of IGF-II, a construct consisting of repeat 11 fused to the transmembrane and cytoplasmic domain of the M6P/IGF-II receptor was transfected into mouse embryonic fibroblasts. The construct was expressed as a stable membrane protein which binds IGF-II with a 10-fold lower affinity as observed for the M6P/IGF-II receptor and is found at the cell surface and in endosomes. It mediates the internalization of IGF-II and its delivery to lysosomes, suggesting that it can function as a IGF-II mini-receptor controlling the extracellular IGF-II level.

Animals↗
PubMed2000

Diastereoselective ring-closing metathesis in the synthesis of dihydropyrans

An investigation into the factors influencing the diastereochemical outcome of the ring-closing metathesis based synthesis of dihydropyrans is presented in this paper. Divinyl carbinols derived from alpha-hydroxy carboxylic acid esters are elaborated to trienes with two diastereotopic vinyl moieties. Depending on the steric demand of the oxo substituent of the divinyl carbinol moiety (either unprotected OH, TBDMS, or benzyl ether) different diastereomers are preferrably formed upon ring-closing metathesis. An extension to diastereoselective double ring-closing metathesis in the formation of spirocycles has also been investigated.

Journal Article↗
PubMed2000

Simple algorithm derived from a geno-/phenotypic database to predict HIV-1 protease inhibitor resistance.

BACKGROUND: Resistance against protease inhibitors (PI) can either be analysed genotypically or phenotypically. However, the interpretation of genotypic data is difficult, particularly for PI, because of the unknown contributions of several mutations to resistance and cross-resistance. OBJECTIVE: Development of an algorithm to predict PI phenotype from genotypic data. METHODS: Recombinant viruses containing patient-derived protease genes were analysed for sensitivity to indinavir, saquinavir, ritonavir and nelfinavir. Drug resistance-associated mutations were determined by direct sequencing. geno- and phenotypic data were compared for 119 samples from 97 HIV-1 infected patients. RESULTS: Samples with one or two mutations in the gene for the protease were phenotypically sensitive in 74.3%, whereas 83.6% of samples with five or more mutations were resistant against all PI tested. Some mutations (361, 63P, 71V/T, 771) were frequent both in sensitive and resistant samples, whereas others (241, 30N, 461/L, 48V, 54V, 82A/F/T/S, 84V, 90M) were predominantly present in resistant samples. Therefore, the presence or absence of a single drug resistance-associated mutation predicted phenotypic PI resistance with high sensitivity (96.5-100%) but low specificity (13.3-57.4%). A more specific algorithm was obtained by taking into account the total number of drug resistance-associated mutations in the gene for the protease and restricting these to certain key positions for the PI. The algorithm was subsequently validated by analysis of 72 independent samples. CONCLUSION: With an optimized algorithm, phenotypic PI resistance can be predicted by viral genotype with good sensitivity (89.1-93.0%) and specificity (82.6-93.3%). The reliability and relevance of this algorithm should be further evaluated in clinical practice.

Acquired Immunodeficiency Syndrome↗
PubMed2000

[Unusual localization in primary hyperparathyroidism].

BACKGROUND: Cystic degenerations of parathyroid adenoma appear in 4 to 5% of all cases. These tumors might be localized in the mediastinum. Until now very few cases of cystic parathyroid adenoma have been published. Difficulties in the diagnosis are common because these adenomas are often thought to belong to other anatomic structures. Persistence of hyperparathyroidism and elevated surgical complications can be the consequences. CASE REPORT: We report on the case of a 76-year-old patient with primary hyperparathyroidism. Pre-operative ultrasound revealed a suspicious lesion near the left upper lobe of the thyroid and an unclear cystic structure in the upper posterior mediastinum, suspected as cervical cyst or dysontogenetic cyst. Additional investigations concerning the cystic mediastinal lesion suggested the following differential diagnoses: goiter (X-ray), bronchogenic cyst, cervical cyst or esophageal diverticulum (CT). During the operation no adenoma could be found on the left side, but when the cystic mediastinal lesion was finally removed it turned out to be a giant cystic activated parathyroid adenoma. Postoperatively calcium, phosphate and PTH levels returned to normal. CONCLUSION: In patients with primary hyperparathyroidism, unclear cystic mediastinal masses should be taken into consideration.

Aged↗
PubMed2000

A de novo synthesis of 2,6-dideoxy-C-aryl glycosides based on ring closing metathesis and diastereoselective epoxide cleavage/anomerization reactions.

[formula: see text] This paper describes a synthesis of enantiomerically pure 2,6-dideoxy-C-aryl glycosides, starting from non-carbohydrate precursors. The synthesis starts from homoallylic alcohols (obtained in enantiomerically pure form by enzymatic resolution), which are elaborated to dihydropyrans using ring closing metathesis as the key step. Epoxidation and epoxide cleavage complete the synthesis. The stereochemical outcome of the sequence depends on the conditions of the epoxide cleavage reaction.

Alcohols↗