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Biomedical subjects

B Schwarz

Publications and source records attributed to B Schwarz.

At least 55 records · Page 3Linked to original sources
PubMed1995

Dopamine-1-receptor stimulation and mucosal tissue oxygenation in the porcine jejunum.

OBJECTIVE: To evaluate the effects of dopamine-1-receptor stimulation on intestinal mucosal tissue oxygenation. DESIGN: Prospective, experimental, controlled trial. SETTING: Animal research laboratory. SUBJECTS: Anesthetized domestic pigs (30 to 45 kg). INTERVENTIONS: A small segment of the jejunal mucosa and serosa was exposed by midline laparotomy and antimesenteric incision. Fenoldopam, a selective dopamine-1-receptor agonist, was infused in steps, exponentially increasing from 0.6 to 9.6 micrograms/kg/min via a central venous catheter (n = 8, fenoldopam group), whereas a second group (n = 6, saline group) was only given the solvent. MEASUREMENTS AND MAIN RESULTS: Systemic hemodynamics as well as systemic and jejunal acid base and blood gas variables were measured using an arterial catheter, a thermodilution pulmonary artery catheter, and a jejunal venous catheter. Jejunal mucosal and serosal tissue PO2 were measured by means of Clark-type surface oxygen electrodes. Oxygen saturation and relative concentration of mucosal microvascular hemoglobin were measured by means of tissue reflectance spectrophotometry. In the fenoldopam group, systemic oxygen delivery (12.5 +/- 0.8 mL/kg/min at baseline) increased by 56% (p < .001) above baseline values. Mean arterial pressure remained unchanged. Fenoldopam produced a 51% increase in mucosal PO2 (23.8 +/- 2.8 torr [3.2 +/- 0.4 kPa] at baseline; p < .001) and a 31% increase in mucosal hemoglobin oxygen saturation (55.4 +/- 8.3% at baseline; p < .001), but not change in serosal PO2 (58 +/- 4.8 torr [7.7 +/- 0.6 kPa] at baseline). CONCLUSIONS: Fenoldopam improves tissue oxygenation of the porcine jejunum in a dose-related manner. This effect is limited to the inner mucosal layer. Dopamine-1-receptor agonists should be evaluated in patients presenting with signs of intestinal mucosal ischemia.

Animals↗
PubMed1995

[Social medicine aspects of pre- and postmenopause].

Due to the increasing life expectancy most women nowadays suffer from menopausal problems. These include not only menopausal symptoms, but also osteoporosis and atherosclerosis. Hormone replacement therapy therefore is a measure for keeping physiological standards. It has both preventive and therapeutic importance, for the individual as well as for the public. Menopause Management is a task for lifestyle medicine, as a combination of pharmaceutical treatment and lifestyle changes. The women and physicians are working in a menopause managing team, and prevention and treatment of diseases and disorders are not separated.

Adult↗
PubMed1995

[Cost effectiveness of misoprostol therapy in prevention of NSAID-induced stomach ulcers].

The efficacy of 400 micrograms misoprostol daily in the prevention of NSAID (non-steroidal anti-inflammatory drug)-induced gastric ulcer has been proven. We calculated the cost-effectiveness of a 3-month course of treatment of 200 micrograms twice daily for patients of the sick fund "Wiener Gebietskrankenkasse", based on charges of the year 1993. Since efficacy in preventing NSAID-induced gastric ulcers has not yet been proven for any other drug, we compared misoprostol-treated patients with untreated controls. The model was based on the following assumptions: 70% compliance with respect to misoprostol treatment, 5.6% incidence of gastric ulcer in patients protected with misoprostol, 21.7% incidence among unprotected NSAID users, 20% hospitalisation among patients with gastric ulcer. When using "Kassenpreis" (drug price paid by the sick funds) misoprostol treatment is cost-effective at costs of AS 64,100,--for inpatient care, upwards and at costs of AS 43,361,-upwards when using "Apothekeneinstandspreis" (drug price paid by pharmacies to wholesalers). In Austria costing system of inpatient care is based on a per diem fee. In 1993 the above costs corresponded to an average of 13 and 9 days, respectively, of inpatient care in Vienna. But costs of care increase by almost 25% per year and, hence, this conclusion is only temporarily valid and already in 1994 cost-effectiveness will be reached in less days of inpatient care. Sensitivity analysis shows that cost-effectiveness mainly varies according to the incidence of gastric ulcer among unprotected adults, and the hospitalisation rate of gastric ulcer patients. Efficacy (gastric ulcer rate among misoprostol treated patients) and compliance have a relatively low impact.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Preoperative radiochemotherapy in primary non-resectable rectal cancer].

PURPOSE: In a pilot-study patients with primarily non-resectable rectal cancer received a pre-operative radiochemotherapy to assess the tolerance and efficacy of this treatment protocol. PATIENTS AND METHOD: Twenty patients with non-resectable rectal cancer (Mason CS III-IV) have been irradiated from September 1989 through February 1994. The total dose, calculated at the isocenter, was 50.4 Gy with 5 fractions of 1.8 Gy per week with a small volume boost in selected cases. Chemotherapy was administered on 5 consecutive days in week 1 and 5 with 1000 mg/m2 5-FU per day as continuous infusion over 120 hours. RESULTS: The treatment was well tolerated. Acute toxicity included 1 grade III-dermatitis, 7 grade II-enteritis, 1 grade III- and 3 grade II-leucopenia. Seventeen out of 20 patients were resected 6 weeks after radiochemotherapy, 3 patients had no surgery (1 toxic death due to septicemia, 1 refusal of surgery after complete remission, 1 thrombocytopenia due to liver cirrhosis), all 3 had at least partial remission of their tumors. Fourteen out of 17 (82%) resections were curative (R0) with 1 additional R1- and 2 R2-resections. Ten out of 14 (71%) curative resected patients had no lymph node metastasis. A detailed histological examination showed regression in 15/16 tumors with fibrosis and vascular wall changes. Nine out of 16 patients had only minimal residual tumor. CONCLUSIONS: In this pilot study, pre-operative radiochemotherapy was well tolerated. The relatively high rate of curative resections and marked histological tumor regressions of this approach requires further investigations in a randomized trial.

Adenocarcinoma↗
PubMed1995

[The Parent Questionnaire in Family-Oriented Rehabilitation/Oncology--an instrument for inpatient quality assurance].

Improved long-term survival rates in childhood cancer have resulted in an increased demand for family-centered care programs. The EFR-O was developed as a screening-instrument tapping parental stressors and resources. The instrument was designed in order to assist family health care providers in allocating parents to need-centered rehabilitation services.

Adaptation, Psychological↗
PubMed1994

Coffee, tea, and lifestyle.

BACKGROUND: Previous reports have indicated that coffee drinking is associated with an unhealthy lifestyle, compared with tea drinking, which may confound the effect in relation to coronary risk factors. METHODS: In a population sample of 2,400 25- to 64-year-old men and women, associations of lifestyle factors with coffee and tea consumption were analyzed. Lifestyle factors were related to four realms of behavior: smoking, eating, drinking, and physical activity. RESULTS: Overall response rate exceeded 77%. Twenty-two behavioral factors were included in the analysis and controlled for age and sex. Mean daily cigarette consumption, the consumption of main fat sources (meat and sausages) and lemonade drinking increased with coffee and decreased with tea consumption. Conversely, intake of fresh fruits, drinking of juice or mineral water, and physical activity on the way to work decreased with coffee and increased with tea. The strongest associations were between coffee, than tea, and cigarette smoking. Controlling smoking (and physical activity) changed trends mainly with respect to alcoholic drinks. CONCLUSIONS: We conclude that drinking coffee is positively associated with factors that promote coronary heart disease, while drinking tea is associated with a preventive lifestyle. Factors supporting these results were found located in all realms of lifestyle for both for coffee and tea. Therefore, investigations on the health effects of coffee and tea must be carefully controlled for confounding behavioral parameters.

Adult↗
PubMed1994

Factors delaying treatment of acute myocardial infarction.

The study was set up to investigate factors delaying treatment of acute myocardial infarction. Nine hundred and sixty-seven Austrian physicians submitted data on their most recent case of myocardial infarction in a cross-sectional study. Mean time for seeking medical care was 111 min from onset; mean admission time to the hospital was 136 min. The degree of anxiety and fear perceived by the patient was positively associated with an earlier decision. Adjusted means of decision time according to degree of fear ranged from 29 to 133 min, adjusted means of admission time from 77 to 153 min. Decision time and admission time were negatively associated with the presence of typical symptoms and a history of myocardial infarction. Adjusted means of decision time according to symptom-history category ranged from 75 to 134 min, adjusted means of admission time from 110 to 151 min. Admission time was also higher in men when patients lived alone, and if the journey to the hospital was a 40 min or more car drive (i.e. 90th percentile). We conclude that measures that increase awareness in patients at risk are vital to reduce delays in seeking medical care and hospital admission, and thus to improve the prognosis of acute myocardial infarction.

Aged↗
PubMed1994

[Epidemiology of hyperlipidemia in Austria].

Hyperlipidemia is the most prevalent coronary risk factor in Austria. Several Austrian expert statements classified total cholesterol levels in adults below 200 mg/dl (5.17 mmol/l) with "normal", levels from 200 to 250 mg/dl (5.17 to 6.47 mmol/l) with "risk", and levels above 250 mg/dl (6.47 mmol/l) with "high risk". Based on different epidemiological studies we estimate that 25% of Austrians have "normal" and 75% elevated total cholesterol levels (50% "risk", respectively 25% "high risk"). Methodological factors prohibit general estimates for HDL-cholesterol and triglycerides based on present data. In a randomized survey among 25- to 64-year old adults in Western Austria, prevalence of low HDL-cholesterol levels below 35 mg/dl (0.91 mmol/l) was 4.0% in men, and 1.3% in women. Prevalence of triglyceride levels above 200 mg/dl (2.29 mmol/l) was 21.5% in men and 8.0% in women.

Adult↗
PubMed1993

[Factors delaying therapy in myocardial infarct].

The timelag from onset of myocardial infarction to beginning of treatment is significantly correlated with prognosis, especially since introduction of thrombolytic therapy. Based on the last case of 967 Austrian physicians (general practitioners and internists, working in an office or in a hospital) we investigated possible factors delaying the beginning of treatment. On the average it took 111 minutes from onset of symptoms until the patient contacted physicians working in offices. The overall mean from onset of symptoms to hospital admission was 136 minutes. Within the hospital almost no delay was reported. Main factors for delay were repression or suppression and misinterpretation of symptoms. Thus, the biggest potential for an early onset of treatment lies within the patients response to onset of symptoms. Measures improving knowledge about mechanisms of the disease of known or possible coronary heart disease patients are most important. Side-effects, such as over-critical or demanding patients should be avoided. In any case they should not distract from the importance of measures improving patients response.

Aged↗
PubMed1993

[Economic public health aspects of benign prostatic hyperplasia in Austria].

Benign prostatic hyperplasia (BPH) is one of the most frequent diseases in advanced aged men. The introduction of a new coding system (ICD-VESKA) in 1989 made it possible to analyze the number of hospitalized cases and to calculate the costs of inpatient care. In 1990 10,710 BPH cases were treated within Austrian hospitals. Controlling for multiple entries 9,742 individual patients (269.4 per 100,000) were treated 138,761 days. Case fatality was 0.5% (46 deaths). The number of inpatients comprises only the top 1,3% of morbidity, the total number is estimated with 770,000 patients. Based on the official nursing fees total costs in public affiliated hospitals were AS 250 millions. Including private hospitals total costs increase to AS 306 millions. The inpatient care of BPH represents only a small proportion of the total health and economic burden, which obviously mainly occurs in the outpatient system. Therefore BPH is one of the diseases of which social and economic importance is usually underestimated due to a lack of information.

Adolescent↗
PubMed1993

[Health economics of early summer meningoencephalitis in Austria. Effects of a vaccination campaign 1981 to 1990].

Tick-borne encephalitis (TBE) was until the early 1980s among the most frequent causes of viral induced central-nervous infectious diseases in Austria. Since 1981 the vaccination was forced by intensive media campaigns. Aim of this study was to investigate the effects of the media campaigns and to evaluate them under health economic criteria. The number of hospitalized TBE-cases declines from 1981 to 1990, the linear trend shows a reduction from 427 to 109. If the linear trend from 1971 to 1980 would have continued the respective number in 1990 would have been 585 cases. Thus the model shows that from 1981 to 1990 more than 50% or 2,690 out of 5,368 possible cases are prohibited, from 1991 to 2000 based on the 1990 vaccination rate approximately 85% or 500 cases annually. In the age group 7 to 14 years the proportion of protected exposed is almost 97%. The loss of quality of life is higher than represented by the inpatient statistics. Many of the TBE victims have chronic impairments, mainly due to paresis and depression. Based on the 1990 cost data economic benefits for the social insurance companies in the decade 1981 to 1990 are AS 147 millions for inpatient care, respectively AS 108 millions for loss of productivity and AS 77 millions for early retirement, resulting in total benefits of AS 331 millions. The estimated benefits for 1991 to 2000 based on 1990 cost data are AS 270 millions for inpatient care, AS 200 millions for loss of productivity, and AS 368 for early retirement (total AS 828 millions).

Austria↗
PubMed1993

[Osteoporosis. Attitude and opinion of Austrian physicians].

251 participants of a representative sample of Austrian physicians (general practitoners, gynecologists, internists) stated their attitudes towards osteoporosis risk factors and methods of prevention. About half of the doctors believe that osteoporosis has less influence on public health than coronary heart disease, stroke or diabetes. Concerning osteoporosis they estimate prevention as most important. For the doctors the most effective preventive strategies, for pre- as well as for postmenopausal women, are physical activity, high calcium intake, and postmenopausal estrogen replacement therapy. Some of the risk factors are very close to the individual lifestyle (e.g. physical activity, nutrition and smoking), 83% of the physicians think that lack of exercise has a great influence on osteoporosis risk, 64% think the same about low calcium intake, 95% about lack of estrogen and 80% about positive family history. Within the physicians as well as the general population osteoporosis awareness is most important concerning growing life expectancy and demographic aspects. Due to this fact it is essential that more than two thirds of the doctors estimate preventive measures as successful.

Adult↗
PubMed1992

Hyperglycemia and coronary risk factors results from western Austria.

We investigated mean levels and prevalences of total cholesterol, HDL cholesterol, triglycerides, fasting blood glucose, systolic blood pressure and body mass index in adults aged 25 to 64 years participating in the WHO Country-wide Integrated Noncommunicable Diseases Intervention (CINDI) Programme in Vorarlberg, western Austria. According to the Austrian expert panel and based upon the above age standardized risk factors 50.9% of the male and 29.3% of the female population were at high risk for developing coronary heart disease. Risk factor levels were further compared between euglycemic and hyperglycemic participants. After adjusting for age hyperglycemia was associated with higher body mass index in men (p = 0.026) and women (p less than 0.001), higher systolic blood pressure in men (p less than 0.001) and women (p = 0.003), and higher levels of triglycerides in women (p = 0.008). No significant differences were observed in total and HDL cholesterol in either sex. When controlling for age and body mass index, fasting blood glucose levels had significant associations only with systolic blood pressure in men (p = 0.001). But, with respect to all risk factors, hyperglycemic participants had an age-adjusted adverse coronary risk profile both in men (p = 0.002) and in women (p less than 0.001).

Adult↗
PubMed1992

[Food service in Austrian hospitals: results of a survey].

130 medical and 130 administrative heads were asked to fill in a structured questionnaire to obtain an assessment of meals provided in Austrian hospitals. 62 questionnaires in each group were returned fully completed. Meals: öS 46,--are available per patient and day; whereby the costs of special diets are öS 11,--higher on average per day. Diets on offer: 96.8% of the questioned hospitals offered a diabetes diet; 95.2% a weight-reducing diet, 93.5% a light balanced diet and diet for patients with hyperlipidaemia and 90.3% a reduced salt diet (the worst accepted by the patients). 90.3% of these hospitals would consider dietary recommendations as a preventive measure. In fact, preventive dietary measure are implemented in 75.5% of the hospitals questioned. It was apparent that the staff in charge are aware of the influence of correct-nutrition in hospitals. It is recommended that nutritional advice should be offered more often in all wards (this is at present available in only 8.0% of the hospitals). It should be mentioned that financial resources concerning hospital meals should be increased for the more widespread establishment of "healthy food", too.

Austria↗
PubMed1992

[The atheroprotective importance of estrogen substitution from the social medicine viewpoint].

Due to the increasing life expectancy most women nowadays suffer from menopausal problems. These include not only menopausal symptoms, but also osteoporosis and atherosclerosis. Hormone replacement therapy therefore is a measure for keeping physiological standards. It has both preventive and therapeutic importance, for the individual as well as for the public. In the following we give an overview to these aspects, focusing on prevention of atherosclerosis.

Arteriosclerosis↗