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C Maier

Publications and source records attributed to C Maier.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Pitfalls in medical expert evaluation. Of "credible" probands and "convincing" experts].

Periodical reading of medical expert opinions reveals deficient assessment-knowledge on the part of German physicians. Six characteristic cases are presented and discussed. The instructive examples show how careless doctors risk their reputation. Inadequate expert opinions are useless. Courts cannot judge correctly, administrations cannot decide in time, insurance companies cannot regulate reasonably. Finally inferior assessments harm more than they serve--especially the doctor's reputation.

Adult↗
PubMed2003

Bilateral motor cortex disinhibition in complex regional pain syndrome (CRPS) type I of the hand.

BACKGROUND: Complex regional pain syndrome type I (CRPS I) develops as a consequence of trauma affecting the limbs, without obvious nerve lesion. Its features include pain, edema, autonomic dysfunction, movement disorder, and trophic changes. CNS involvement is suggested by the symptoms, but the pathophysiology of CRPS I is unknown. OBJECTIVE: To assess excitability changes in the motor cortex in patients with CRPS I. METHODS: The authors studied 25 patients with unilateral CRPS I involving the hand by means of transcranial magnetic stimulation using a paired-pulse paradigm. Motor threshold (MT) and intracortical inhibition and facilitation were determined on the affected and the clinically unaffected side. A control group of 20 healthy subjects was studied. RESULTS: The authors found a significant reduction of intracortical inhibition on both sides of patients with CRPS compared with control subjects, whereas intracortical facilitation and MT did not differ significantly. However, in the patients' group, the presence of allodynia significantly decreased MT. CONCLUSIONS: The authors showed a bilateral disinhibition of the motor cortex in patients with complex regional pain syndrome.

Adult↗
PubMed2003

[Recent trends in understanding and therapy of complex regional pain syndromes].

Since the term "complex regional pain syndromes" (CRPS) was introduced based on a revised taxonomy for disorders previously called reflex sympathetic dystrophy and causalgia in 1995, much knowledge grew up on the understanding and therapy of the disease. This review gives an overview on the clinical characteristics, pathophysiology, diagnostic tools and therapeutic options in CRPS. It will especially focus on recent findings on the role of the sympathetic nervous system, the central nervous system and peripheral inflammatory processes as underlying mechanisms. Although there is no diagnostic gold standard, careful clinical evaluation and additional apparative test procedures are very helpful for the diagnosis. An early and interdisciplinary approach is the basis for an optimal and successful treatment.

Causalgia↗
PubMed2003

[Complex regional pain syndrome. Sympathetic reflex dystrophy and causalgia].

Complex regional pain syndromes (CRPS) occur as the inadequate response to painful trauma in a distal extremity. With CRPS I (sympathetic reflex dystrophy), no lesion of the nerve is present. Aside from sensory disturbances, burning deep spontaneous pain and mechanical allodynia are characteristic. Disturbances in the skin blood circulation,sweating,edema,and trophic disturbances of the skin, joints, and bones are typical. Reduction in muscle strength, tremor, and late dystonic changes comprise the motor disturbances. All symptoms are distributed in the distal extremity and not limited to the region of the peripheral nerves. Complex regional pain syndrome II (causalgia),develops following a partial peripheral nerve lesion. The distally generalized symptoms are identical. Successful therapy depends on an early start of interdisciplinary treatment. In addition to the pain therapy,physiotherapy plays a decisive role in rehabilitation. During the acute phase, freedom from pain at rest and retrogression of the edema must be achieved. With slight spontaneous pain, a conservative therapeutic method may be applied (analgesics, rest, raised position). In case of insufficient improvement and in difficult cases, the effect of intervention (sympathetic blockade) should be tested and possibly a blockade series performed. After reduced spontaneous pain,physiotherapy should be increased stepwise.

Analgesics↗
PubMed2003

[Validation of the German Mainz Pain Staging System in different pain syndromes].

OBJECTIVE: Our study was carried out to clarify whether differences in pain intensity,pain-related disability,depression and quality of life change with respect to the stage of chronicity of the Mainz Pain Staging Study (MPSS) in different pain syndromes. Keywords. METHODS: All patients with an initial pain clinic consultation from July 2000 to July 2001 and suffering from four major pain syndromes ("headache", "neuropathic pain", "back pain" or "muscle and joint pain") were included. Indicators of validity were several self-rating scales from the German pain questionnaire of the German Chapter of the International Association for the Study of Pain (DGSS). Patient data were collected using QUAST, a database environment specifically developed for documentation and quality assurance in pain therapy. An assessment was made for each of the four major diagnoses to determine whether patients in the three chronicity stages differed in their psychometric test results. In addition,the four diagnosis groups were tested for differences from one another. RESULTS: A total of 862 patient charts with documented pain syndromes and MPSS were extracted and analyzed. The extent of the subjective psychosocial stress and disability increased in all diagnosis groups and was correlated with the chronicity stage. The proportion of patients with an indication of clinically relevant depression (ADS score >23) increased with chronicity regardless of the pain diagnosis. The four main diagnosis groups differed with respect to the chronicity stage according to MPSS (P<0.001), with headache patients being classified predominantly as stage I. Patients with an additional pain diagnosis had a higher chronicity stage (P<0.001). CONCLUSION: Our results underline the validity of the MPSS for the four diagnosis groups examined; however, pain diagnosis must be controlled in all studies using chronicity stage as an independent variable, e.g., therapy studies. For optimal results physicians must closely follow the test instructions of the MPSS.

Databases, Factual↗
PubMed2003

NMDA-mediated mechanisms in cortical excitability changes after limb amputation.

OBJECTIVES: The aim of our study was to determine the role of N-methyl-d-aspartate (NMDA)-mediated mechanisms in cortical excitability changes after limb amputation, and their possible relationship to phantom pain. MATERIALS AND METHODS: Sixteen upper limb amputees who were suffering from chronic phantom pain received the NMDA-antagonist memantine or placebo for 3 weeks. Intracortical inhibition (ICI) and intracortical facilitation (ICF) were determined at baseline and on day 21 using transcranial magnetic stimulation. Simultaneously, phantom pain intensity was assessed. RESULTS: Memantine reduced ICF and enhanced ICI to roughly the same extent as seen in healthy subjects in a previous study. These changes were not correlated to the reduction of phantom pain. CONCLUSION: We therefore conclude that NMDA-mediated mechanisms influence changes of ICI and ICF occurring after limb amputation. However, our results suggest that these cortical excitability changes and phantom pain are independent of each other.

Adult↗
PubMed2002

[Postoperative pain therapy in Germany].

OBJECTIVE: A survey was performed to obtain information on the organization and practice of postoperative pain management. METHODS: A questionnaire was mailed to 773 directors of German departments of anesthesiology. RESULTS: A total of 446 replies (57.7%) could be analyzed. Of the departments, 161 (36.1%) had established an acute pain service (APS), more often in hospitals > or = 1000 beds (63%) than in hospitals with 400-999 beds (40%) and hospitals with < 400 beds (27%). Epidural analgesia was practiced in 97% of the departments, however, it was the analgesic technique of choice for larger abdominal surgery or amputation of the lower limb only in 60.8% and 45.5% of the departments, respectively. Departments with APS provided epidural analgesia more often on general wards than departments without APS (88.2% vs. 68.4%, p < 0.01). Technically more challenging methods (e.g. catheters for regional anesthesia, PCA, PCEA) were more often provided in hospitals running an APS (p < 0.001). CONCLUSIONS: The number of departments with APS has increased over the last 10 years. Future decisions on reimbursement should consider this extensive service.

Analgesia, Epidural↗
PubMed2002

[Does intraoperative hyperventilation improve neurological functions of older patients after general anaesthesia?].

UNLABELLED: The purpose of the study was to investigate the effect of intraoperative hyperventilation on postoperative cognitive functions. METHODS: A total of 120 patients (60 older and 60 younger than 65 years old) were allocated randomly to group I "hyperventilation" (p(et)CO(2)=30 mmHg) or group II "normoventilation" (p(et)CO(2)=45 mmHg). Before the operation and on days 1, 3 and 6 after the operation, a battery of neuropsychological tests was performed (concentration endurance test d2, number connection test, digit symbol test). A decline of 20% in at least one test was regarded as postoperative cognitive deficit (POCD). Anaesthesia was maintained with isoflurane in nitrous oxide/oxygen supplemented with fentanyl. RESULTS: In all patients pooled, POCD was present in 26 patients (22%). In patients older than 65 years, POCD was present in 3 cases after hyperventilation and 13 cases after normoventilation ( p<0.01). In younger subjects, 5 cases of POCD were diagnosed in each ventilation group. Furthermore, POCD was more severely pronounced in older patients after normoventilation. CONCLUSION: In older patients, POCD occurred more frequently after intraoperative normoventilation. We assume that a reduced amount of noxious substances reach the brain after hyperventilation, because hyperventilation reduces the cerebral blood flow.

Aged↗
PubMed2002

[Complex regional pain syndrome. Reflex sympathetic dystrophy and causalgia].

Complex regional pain syndromes (CRPS) occur as the inadequate response to painful trauma in a distal extremity. With CRPS I (sympathetic reflex dystrophy), no lesion of the nerve is present. Aside from sensory disturbances, burning deep spontaneous pain and mechanical allodynia are characteristic. Disturbances in the skin blood circulation, sweating, edema, and trophic disturbances of the skin, joints, and bones are typical. Reduction in muscle strength, tremor, and late dystonic changes comprise the motor disturbances. All symptoms are distributed in the distal extremity and not limited to the region of the peripheral nerves. Complex regional pain syndrome II (causalgia), develops following a partial peripheral nerve lesion. The distally generalized symptoms are identical. Successful therapy depends on an early start of interdisciplinary treatment. In addition to the pain therapy, physiotherapy plays a decisive role in rehabilitation. During the acute phase, freedom from pain at rest and retrogression of the edema must be achieved. With slight spontaneous pain, a conservative therapeutic method may be applied (analgesics, rest, raised position). In case of insufficient improvement and in difficult cases, the effect of intervention (sympathetic blockade) should be tested and possibly a blockade series performed. After reduced spontaneous pain, physiotherapy should be increased stepwise.

Causalgia↗
PubMed2002

[Preventing prostate carcinoma in men with familial disposition].

A family history is one of the strongest risk factors for prostate cancer (PC). We evaluated the detection rate of PC in relatives of 119 German PC families that took part in ongoing linkage analyses. Brothers of patients with sporadic prostate cancer aged < 55 years at onset were included as well. Responses were received from 120/196 (61.2%) individuals of the familial and 67/120 (55.8%) of the sporadic group. Findings (DRE, TRUS, PSA) were more often suspicious for carcinoma in the PC families. Prostate cancer was diagnosed in 6 (5.0%) and 2 (2.99%) participants of the familial and the sporadic group, respectively. These detection rates tended to be higher than that of an age-matched subgroup of an unselected population in other European screening studies. The most important risk factor for the diagnosis of PC was a low average age at onset within the family. These data imply that prostate cancer screening in the high-risk group of men with familial predisposition cannot be assessed by population-based studies and should be evaluated separately.

Adult↗
PubMed2002

[Guidelines in pain treatment--methodical quality of guidelines for treatment of pain patients].

The committee for quality assurance of the German IASP chapter (DGSS) evaluated all relevant guidelines concerning pain treatment. Quality of guidelines was analysed according to the checklist "Methodical quality of guidelines" by Ollenschläger and the user manual released by the German Medical Centre for Quality Assurance. The guideline for the treatment of back pain released by the German Medical Association was examined as well as the one released by the German Association for physical therapy and rehabilitation, the guideline on cervical and lumbal nerve root compression syndrome of the German Association of Neurosurgeons, the guideline for cancer pain of the Drug Committee of the German Medical Association was compared with the one of the German Interdisciplinary Association for Pain Treatment. The guideline for the treatment of chronic headache and facial pain of the Medical Association was evaluated and the guideline for the treatment of trigeminal neuralgia of the German Association of Neurosurgery and Neurology, also the guideline for the treatment of acute postoperative and posttraumatic pain. All guidelines show deficiencies in different aspects and of different severity. At first there are deficiencies in interdisciplinary formulation of the guidelines and identification and interpretation of evidence of multimodal pain treatment options. The most prominent deficiency is the lack of implementation and application trials or impulses by all author associations. This way all expenditure on releasing guidelines is given away without improving quality of pain treatment. The authors' recommendation is to adjust to guidelines and, if they are working or not, tell the authors and improve interdisciplinary in pain treatment guidelines.

Analgesics↗
PubMed2002

A candidate gene approach within the susceptibility region PCaP on 1q42.2-43 excludes deleterious mutations of the PCTA-1 gene to be responsible for hereditary prostate cancer.

OBJECTIVE: The Prostate Carcinoma Tumor Antigen-1 (PCTA-1) is located at the prostate cancer susceptibility locus on chromosome 1q42.2-43 (PCaP). In this candidate gene approach, we searched for deleterious mutations within the PCTA-1 gene and its promoter. MATERIALS AND METHODS: Seventy-seven familial prostate cancer cases from 36 German and French pedigrees were screened for germline mutations in the PCTA-1 gene using enzymatic mutation detection (EMD). Putative missense mutations were genotyped by RPLP and ddNTP primer extension assays in 88 controls to assess allele frequencies and haplotypes. RESULTS: Several sequence variants were found but none of the findings indicated a deleterious mutation. Three affected brothers showed an intronic variation, which may interfere with correct splicing. Four non-conservative SNPs were characterized, coding for the amino acid alterations Y19F, C36R, V56M and S184R. All exchanges were found in controls with common allelic frequencies of at least 28%. Haplotype definition including six SNPs within the PCTA-1 gene revealed a complete linkage disequilibrium. Low haplotype diversity leads to a predominance of only two peptide variants of the PCTA-1 protein, coded by 95% of all chromosomes. CONCLUSIONS: PCTA-1 is not a classical high risk gene with deleterious mutations predisposing to hereditary prostate cancer. Its contribution to prostate cancer susceptibility as a low risk factor in sporadic disease has to be assessed in larger samples by association studies.

Galectins↗
PubMed2002

[Computer-assisted system for analysis of heart rate variability in clinical studies].

This paper describes an adaptable framework that facilitates exploratory analysis, interpretation and classification of beat-to-beat data extracted from the electrocardiogram (ECG). The system supports a variety of user-defined annotations and allows the definition of analysis programs. Special care is taken on the correct treatment of corrupted and missing data, ubiquitously found in real world problems. Besides the computation, the performance of single features can be inspected using different kinds of diagrams provided by the system. Combinations of features can be evaluated using a polynomial classifier. Both the computation and combination of features are defined as tasks that can be dispatched by a server to various clients. The framework is easily adaptable to different problem structures and has been used successfully in three studies.

Atrial Fibrillation↗
PubMed2002

Medical Imaging Informatics and Medical Informatics: opportunities and constraints. Findings from the IMIA yearbook of Medical Informatics 2002.

OBJECTIVES: The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of recent excellent papers on medical informatics research (http://www.yearbook.uni-hd.de). The 2002 Yearbook of Medical Informatics took as its theme the topic of Medical Imaging Informatics. In this paper, we will summarize the contributions of medical informatics researchers to the development of medical imaging informatics, discuss challenges and opportunities of imaging informatics, and present the lessons learned from the IMIA Yearbook 2002. RESULTS AND CONCLUSIONS: Medical informatics researchers have contributed to the development of medical imaging methods and systems since the inception of this field approximately 40 years ago. The Yearbook presents selected papers and reviews on this important topic. In addition, as usual, the Yearbook 2002 also contains a variety of papers and reviews on other subjects relevant to medical informatics, such as Bioinformatics, Computer-supported education, Health and clinical management, Health information systems, Knowledge processing and decision support, Patient records, and Signal processing.

Computer-Assisted Instruction↗
PubMed2001

[Medical malpractice 2000. Malpractice from the viewpoint of expert witnesses if a malpractice insurance carrier].

Insurance industry statistics on medical malpractice are rare. The authors, who are in-house medical advisors of the Allianz Versicherungs-AG, report on their assessments of medical malpractice claims in 2000. Orthopedics/traumatology (24%) and gynecology/obstetrics (18%) are the medical fields in which liability demands are currently most frequent. Deviation from the medical state of the art (41%), false diagnosis (21%) and misinformation of patients (13%) are the main actual or alleged violations of the duty of care. The results, which are meant to provide a basis for future comparisons, are discussed with a view to establishing risk management strategies. On the basis of the literature and their own the authors have compiled a set of recommendations--"Ten commandments"--for decreasing medical malpractice claims.

Expert Testimony↗
PubMed2001

Soil fertility limits carbon sequestration by forest ecosystems in a CO2-enriched atmosphere.

Northern mid-latitude forests are a large terrestrial carbon sink. Ignoring nutrient limitations, large increases in carbon sequestration from carbon dioxide (CO2) fertilization are expected in these forests. Yet, forests are usually relegated to sites of moderate to poor fertility, where tree growth is often limited by nutrient supply, in particular nitrogen. Here we present evidence that estimates of increases in carbon sequestration of forests, which is expected to partially compensate for increasing CO2 in the atmosphere, are unduly optimistic. In two forest experiments on maturing pines exposed to elevated atmospheric CO2, the CO2-induced biomass carbon increment without added nutrients was undetectable at a nutritionally poor site, and the stimulation at a nutritionally moderate site was transient, stabilizing at a marginal gain after three years. However, a large synergistic gain from higher CO2 and nutrients was detected with nutrients added. This gain was even larger at the poor site (threefold higher than the expected additive effect) than at the moderate site (twofold higher). Thus, fertility can restrain the response of wood carbon sequestration to increased atmospheric CO2. Assessment of future carbon sequestration should consider the limitations imposed by soil fertility, as well as interactions with nitrogen deposition.

Atmosphere↗
PubMed2001

Community perception of school-based delivery of anthelmintics in Ghana and Tanzania.

This paper presents the results of an evaluation of community perception of two large-scale, government-run, school-based health programmes delivering anthelmintic drugs to primary school children, in Ghana (80 442 children in 577 schools) and Tanzania (110 000 children in 352 schools). Most teachers (96% in Ghana and 98% in Tanzania) were positive about their role in the programme, including administration of anthelmintic drugs, and parents and children fully accepted their taking on this role. The benefits of the programme were apparent to teachers, parents and children in terms of improved health and well-being of the children. Over 90% of parents in both Ghana and Tanzania indicated a willingness to pay for the continuation of drug treatment. The evaluation also highlighted areas that are critical to programme effectiveness, such as communication between schools and parents, the issue of collaboration between the health and education sectors, parents' perception of the importance of helminth infection as a serious and chronic health problem (compared with more acute and life threatening illnesses such as malaria), and who should pay for treatment of side-effects.

Adult↗