Biomedical subjects

E Neugebauer

Publications and source records attributed to E Neugebauer.

At least 19 recordsLinked to original sources

PubMed1999

Diagnosis and treatment of diverticular disease: results of a consensus development conference. The Scientific Committee of the European Association for Endoscopic Surgery.

BACKGROUND: With the aim of resolving the current controversy over the diagnosis and treatment of diverticular disease, this consensus development conference set out to summarize the actual state of the art. METHODS: A multidisciplinary panel of international experts (n = 16) was selected to take part in the consensus process. Prior to the conference, all experts were asked to answer a series of questions on diverticular disease. The consensus statement compiled out of these evaluations was modified during a joint meeting of the panel members, then presented for discussion in a public session, and finally revised by the expert panel. The finalized statement was mailed to all panel members for approval (Delphi method). RESULTS: Asymptomatic diverticulosis, diverticular disease (with actual or recurrent symptoms), and complicated diverticular disease were defined separately. No agreement was reached on whether barium enema or colonoscopy is the better choice as an initial diagnostic tool in uncomplicated cases. In complicated cases, computed tomography is recommended for diagnosis. After two attacks of diverticular disease, elective resection should be considered. For patients in whom a concomitant carcinoma cannot be excluded and those with chronic complications (fistula, stenosis, or bleeding) surgery is also indicated. Laparoscopic sigmoid colectomy is recommended only for uncomplicated and, after percutaneous drainage of abscesses, Hinchey stage I and II cases. CONCLUSIONS: Laparoscopic surgery has already begun to influence the management of diverticular disease, but the randomized controlled trials needed to support therapy decisions are largely missing.

Diverticulitis↗

PubMed1998

Neutrophil adhesion to histamine stimulated cultured endothelial cells is primarily mediated via activation of phospholipase C and nitric oxide synthase isozymes.

OBJECTIVE AND DESIGN: In order to understand the underlying mechanism of histamine stimulated inflammatory responses, histamine receptor subtypes and signal transduction pathways by which histamine mediates the stimulation of neutrophil adhesion to endothelial cells has been studied in vitro. MATERIAL: Human neutrophils and human umbilical vein endothelial cells. TREATMENT: Confluent human endothelial cell layer were incubated with histamine (1 mM), H1, H2 or H3 receptor agonists: fluorophenylhistamine (10 microM), amthamine (10 microm), methylhistamine (10 microM), respectively. Ten minutes prior to histamine (1 mM) stimulation H1, H2 or H3 receptor antagonists (dimethindene, 100 microM; famotidine, 1OO microM, thioperamid 100 microM, respectively) were added. Histamine stimulated signal transduction pathways were inhibited by adding phospholipase C inhibitor 2-nitro-4-carboxyphenyl N,N-diphenylcarbamat (200 microM), adenylate cyclase inhibitor 9-(2 tetrahydrofuryl)adenine (80 microM), nitric oxide synthase isozymes inhibitor S-ethylisothiourea (1 microM) or guanylate cyclase inhibitor (LY 83583; 10 microM). Neutrophil adhesion was monitored at 30, 60, 90, 120, 150, 180 and 210 min. METHODS: Neutrophil adhesion to endothelial cells was quantified by analysing alkaline phosphatase activity. RESULTS: Histamine stimulation of endothelial cells resulted in a biphasic time and concentration dependent pattern of neutrophil adhesion. This pattern of neutrophil adhesion was mimicked by stimulation of endothelial cells with H1 or H2 agonists. Stimulation of endothelial cells with an H3 agonist had no effect on neutrophil binding. Inhibition of phospholipase C (PLC), nitric oxide synthase isozymes (NOS) or guanylate cyclase (GC) resulted in a significant decrease of neutrophil binding to histamine or agonist stimulated endothelial cells. An increase of neutrophil binding to unstimulated or to agonist stimulated endothelial cells was observed during inhibition of adenylate cyclase. CONCLUSIONS: Our results suggest that histamine stimulated neutrophil adhesion is due to H1 and H2 receptor mediated activation of PLC, NOS and GC. Increase of cAMP concentration seems to mediate an inhibitory effect on PMN adhesion to endothelial cells.

Cell Adhesion↗

PubMed1998

[The status of perioperative pain therapy in Germany. Results of a representative, anonymous survey of 1,000 surgical clinic. Pain Study Group].

To evaluate the status of perioperative pain management we mailed a anonymous postal survey to all 2,254 surgical departments in Germany. We received answers from 1,000 clinics (44.4%) which were representative related to their regional distribution. We asked the responsible surgeons to report their organizational structure and responsibilities for treating pain patients, the significance of the problem, their methods of measuring pain, and the usage of different analgesic drugs and methods. In 47% the surgeon and the anesthesist together had responsibility for adequate postoperative pain treatment; in 33% and 14%, respectively, it was the surgeon and anesthesist alone. Only 41% knew the interdisciplinary statement on pain therapy of the Professional Societies of German Surgeons and Anaesthesists from 1992. Although the importance of postoperative pain is globally acknowledged, only 19.1% of all departments had a written concept for pain treatment. Pain was measured in only 11% of the clinics mainly by using the visual analogue scale. Most surgeons relieve pain solely with systemic drugs. Regional analgesia was used by 18% only 51% of the surgeons decide on the choice and dosage of analgesic therapy on the ward; 33% admit that pain therapy often starts after complaints of the patient. 70% of all surgeons never participated in a congress on pain. We conclude that postoperative pain management in most German surgical departments still lacks effectiveness, adequacy, and organizational and scientific background.

Analgesics↗

PubMed1998

Clinical relevance of sepsis scores.

In this article sepsis scoring systems commonly used are presented as regards their results and shortcomings. Furthermore, in a more general context, the direct and indirect effect on the individual patients is discussed and recommendations are given on how to use scoring systems.

Critical Care↗

PubMed1998

Thirty years of anti-mediator treatment in sepsis and septic shock--what have we learned?

Sepsis, the systemic response (specific and non-specific) of the body to an infection, is an increasing clinical problem. During the last 30 years, nearly 50 clinical trials involving more than 10,000 patients have failed to demonstrate improvement of patients' outcome with different "anti-mediator" strategies. The wrong conceptional approaches to interact with the complex mediator network and flaws in study design and conduct are the main reasons for this disappointing situation. We learned, however, that the systemic host response is more than persistent uncontrolled inflammation; it is also a stimulation of the counter regulatory network. Although it is important to analyse the complex picture, we have now reached a point where more sophisticated strategies for describing complexity and novel attempts for synthesis are needed. Along this line, improved study designs (decrease of "signal-to-noise ratio") are mandatory. In addition, secondary preventive strategies are emphasised.

Clinical Trials as Topic↗

PubMed1998

Outcome after polytrauma.

BACKGROUND AND AIMS: Outcome refers to the different facets of consequences resulting from an event or intervention. These consequences may be relevant for an individual patient, but also for society. There is a growing recognition that clinical research needs to define and focus on the outcomes of medical care. Outcome research should help health care professionals to better evaluate the effectiveness of specific interventions or a therapeutic concept. This broader base of evidence should then benefit the patients. METHODS: The literature was reviewed with respect to concepts of outcome research as well as results of outcome research after major trauma. RESULTS: Measuring outcome might be relevant for research purposes as well as in daily surgical practice. In the past, clinical research in trauma care has tended to focus on survival. Mortality rates are not out, complication rates are not out, but their value is limited and restricted to given scenarios with high mortality rates. New outcomes have to be added: such a functional status, emotional health, social interaction, cognitive function, degree of disability and other indicators of health. CONCLUSION: Despite differences in injury pattern and severity of injury, there is strong evidence from the literature that the quality of life is significantly impaired after major trauma. This is true for functional outcome as well as for psycho-social outcome in up to 70% of patients.

Adult↗

PubMed1998

[Recommendations and guidelines for perioperative pain therapy in Germany].

The management of perioperative and post-traumatic pain in clinical practice is still significantly deficient in Germany as shown in a recently published representative and anonymous survey of 1,000 surgical clinics. Several steps were undertaken to improve the situation: in 1992, an agreement on responsibilities and organization was achieved between the "Berufsverbände" of German Surgeons and of Anaesthesiologists. In 1997, recommendations on the treatment of perioperative and post-traumatic pain were published by the two "Berufsverbände" together with the Scientific Societies of Surgeons and Anaesthesiologists. In 1998, national guidelines based on consensus methods in collaboration with the Association of the Scientific Medical Societies in Germany (AWMF) will be published at the Internet address http://www.uni-duesseldorf.de/WWW/AWMF/.

Analgesics↗

PubMed1998

[Efficacy of an Acute Pain Service--a controlled comparative study of hospitals].

The efficacy of an acute pain service was prospectively evaluated on elective abdominal operations by comparing two surgical departments including a total of 498 patients. The patients of the clinic with an acute pain service reported less pain (at rest and in movement) pre- and postoperatively and received more analgetics. They had more appetite, lower sleep requirements and more independence. The patients' overall satisfaction was greater in the clinic with an acute pain service.

Abdomen↗

PubMed1997

Digital radiography.Results of a survey (part A) and a consensus conference (part B)

Digital imaging (digital image intensifier radiography, storage phosphor/selenium radiography) is increasingly becoming commonplace in radiology departments for diagnostic purposes. Despite 10 years of experience, the advantages and disadvantages of those methods are still heavily discussed among users, financiers and prescribers. This paper is to offer additional arguments for a thorough and objective discussion. No further comments or interpretations have been added to this paper. This paper consists of two main parts, A and B. The first part deals with the results of a user survey, the other part presents the results, i. e. statements, of a consensus conference.

Journal Article↗

PubMed1997

Local and intra-articular infiltration of bupivacaine before surgery: effect on postoperative pain after anterior cruciate ligament reconstruction.

In a double-blind, randomized trial, 40 patients undergoing open anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft were randomly allocated to two groups: group A (n = 20) received an intra-articular instillation of 20 mL bupivacaine (0.25%) and a local infiltration of 20 mL bupivacaine (0.5%) 15 minutes before surgery. Group B (n = 20) received an injection of saline solution in the same manner. Patient-controlled on-demand analgesia (PCA) with intravenous piritramid was used for postoperative pain control. A significant decrease in pain scores on a visual analog scale (VAS scale, 0 to 10) was found in the bupivacaine group (group A) at bedrest on the day of surgery only (pain score, 5.5 v 7.3 (scale, 0 to 10), P < .05). At all other times, no significant differences were found. The overall supplemental opioid requirements were not different between the study groups (63.9 v 62.6 mg piritramid/72 hours). A long-lasting, clinically relevant, pain-reducing effect with infiltration of bupivacaine before surgery could not be shown with this study.

Adult↗

PubMed1997

Trauma score systems: Cologne Validation Study.

BACKGROUND: Most standard trauma score systems have been developed and validated in the United States. However, trauma differs between the United States and Germany. This prospective study tested the validity of eight current trauma scoring systems (Glasgow Coma Scale, Trauma Score, Revised Trauma Score, Injury Severity Score, TRISSTS, TRISSRTS, Prehospital Index, Polytraumaschluessel) in 612 patients in Cologne. METHODS: Between January 1, 1987, and December 31, 1987, 2,136 trauma related emergencies were seen by emergency physicians in the field. All trauma patients with a Trauma Score below 16 and a random sample of 10% of patients with a Trauma Score of 16 were included in the study (n = 625). Follow-up was successfully completed for 612 patients (97%). Their hospital outcome was correlated with their individual score result. RESULTS: All trauma score systems under study showed high accuracy rates. TRISSRTS and TRISSTS performed best with values of above 0.97 for the area under the receiver operating characteristics curve. CONCLUSION: We conclude that the standard trauma score systems are valid tools for patient classification and support TRISSRTS as the international reference score system for the assessment of injury severity. This validation will allow comparisons between different trauma care systems.

Adolescent↗

PubMed1997

[Digital radiography--results of a user survey (A) and consensus conference (B)].

Digital radiography is increasingly replacing conventional radiography in imaging. For some years now, the pros and cons of this new method have been subject to intense discussions. For further discussion, the present article describes the results of an inquiry among users and of a consensus conference held in March 1996 in Munich. Comments and interpretations have been omitted on purpose.

Attitude of Health Personnel↗

PubMed1997

Digital radiography. Results of a survey (part A) and a consensus conference (part B).

Humans↗

PubMed1997

[Apache II score and prognosis of intensive care patients after trauma--results of a quality assurance study of 939 patients].

The APACHE II score is a well-known measure of illness severity and widely used for prognosis in the ICU. A total of 91 trauma patients were identified among 939 ICU admissions (18 months), and their actual mortality (11/91; 12.1%) clearly exceeds the prognosis due to APACHE II (7.1%). Trauma-specific scores (TRISS, ISS, and RTS) revealed much higher estimates: 13%-22% which confirms a systematic underestimation of risk of death score in trauma patients in the APACHE system.

APACHE↗

PubMed1997

[Effective costs of intensive care: TISS and TISS-28 for the evaluation of an intensive care unit].

In 1996, Miranda published the TISS-28, a simplified version of the well-known Therapeutic Intervention Scoring System (TISS) for the evaluation of intensive care. A prospective observational study in 939 patients compared both scores, and the TISS-28 was found to show less interobserver variation. A cost analysis based on 1995 data revealed a value of 68.70 DM per TISS-28 point, which can be used to calculate the average costs for groups of patients, e.g., 1410 DM for 1 day postoperative surveillance in the ICU.

Cost-Benefit Analysis↗

PubMed1996

[Mechanisms of action of high-dosage glucocorticoid therapy].

Explore the source record for details and available documents.

Calcium↗

PubMed1996

Laparoscopic cholecystectomy for acute cholecystitis: is it really safe?

The prospectively collected data from 530 cholecystectomies performed in a university clinic from October 1989 to March 1991 were analyzed after 1 to 3 years of follow-up. The aim of this study was to compare the results of laparoscopic cholecystectomy (LC) for acute cholecystitis with that for routine symptomatic gallbladders. The preoperative, intraoperative, and postoperative parameters of 424 routine (noninflamed) LCs and 54 LCs for acutely inflamed gallbladders were compared under the "intention to treat" principle. Operating time was longer in the inflamed group (median 97 minutes versus 75 minutes; p < 0.0001). Significantly more adhesions (20% versus 8%), more blood loss (48% versus 19%), a higher incidence of bile spillage (28% versus 12%), and lost stones (19% versus 8%) were encountered in patients with acute cholecystitis. Common bile duct (CBD) injuries were also more frequent in that group (5.5% versus 0.2%; p = 0.005). The rate of conversion to open surgery was higher than with routine LCs (13% versus 4%). There were two deaths in the routine LC group and none in the acutely inflamed group. There was no difference in postoperative pain intensity or postoperative fatigue according to visual analog scale measurements. Patients with acute cholecystitis stayed only 1 day longer (median 4 days versus 3 days) in hospital. The quality of life scores indicate return to almost normal values by the 14th postoperative day. Long-term follow-up (1-3 years) did not reveal any delayed clinical adverse effects. In summary, LC for inflamed gallbladders has a higher conversion rate than LC for routine symptomatic gallbladders. If successfully performed, it has definite benefit for the patient in terms of better postoperative recovery. The trade-off is that the risk of CBD injury is significantly higher.

Acute Disease↗

PubMed1996

Histamine release in sepsis: a prospective, controlled, clinical study.

OBJECTIVE: To determine if histamine release occurs in clinical sepsis. DESIGN: Prospective, controlled, clinical study. SETTING: Interdisciplinary intensive care unit and trauma ward. PATIENTS: Sepsis was confirmed in 20 patients (test group) by the criteria of the Veterans Administration Systemic Sepsis Cooperative Study Group (1987) and was verified by positive blood culture. In addition, patients were scored by the Elebute and Stoner Sepsis Score (1983), as modified by Dionigi et al (1985). A concomitant control group consisted of 20 postoperative patients with non-life-threatening trauma to the extremities and without signs of local or systemic infection. INTERVENTIONS: Observational study. Blood samples were collected for determination of plasma histamine concentrations in both groups at the time of study entry and on five succeeding days. MEASUREMENTS AND MAIN RESULTS: The patients were well matched, and the groups were not significantly different for all criteria known to influence histamine release. Comparison of the median values of each group on days 1 through 5 demonstrated significantly higher plasma histamine values in the test group on days 1 through 4, but these values were no longer significantly higher on day 5. While none of the nonseptic control patients achieved a plasma histamine concentration of > 1 ng/mL (the concentration of which was considered to be the pathologic cutoff point representing histamine release), these values (i.e., > 1 ng/ mL) were found in nine of 20 test group patients. In the test group, nonsurvivors (n = 9) had significantly higher plasma histamine concentrations than survivors (n = 11) throughout the whole study and eight of nine nonsurvivors showed a plasma histamine concentration of > 1 ng/mL. Correlation of plasma histamine concentrations on day 1 to sepsis severity (initial Sepsis Score) showed that all but one patient with a combined low Sepsis Score (< 20 points) and histamine concentration of < 1 ng/mL survived, while all patients with a Sepsis Score of > 20 points and histamine release (plasma histamine concentration of > 1 ng/mL) died. CONCLUSION: Increased histamine concentrations were shown to be causally associated (contributory determinant) with sepsis.

Adult↗