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Biomedical subjects

E Neugebauer

Publications and source records attributed to E Neugebauer.

At least 73 records · Page 4Linked to original sources
PubMed1999

Concentrations of lead in liver, kidney, and bone of bald and golden eagles.

The diagnosis of lead poisoning in eagles relies on autopsy information and residue analysis of lead in certain tissues, usually liver or blood. Similarly, the assessment of elevated lead exposure in eagles depends on the determination of lead concentrations in these tissues. Renal and bone lead concentrations have rarely been examined in eagles. We examined relationships among hepatic, renal, and bone lead concentrations in bald and golden eagles from the Canadian prairie provinces. Hepatic and renal lead concentrations were strongly related (R2 = 0.87) while those in liver and bone were significantly but poorly related (R2 = 0.22). Renal lead concentrations of 5 and 18 microg x g-1 (dry weight) corresponded to hepatic lead concentrations of 6 and 30 microg x g-1, the hepatic concentrations that we used as criterion levels associated with elevated lead exposure and death from lead poisoning, respectively. Lead was elevated in 19 of 119 and 21 of 109 liver and kidney samples, respectively. Of these 19 and 21 liver and kidney samples, 14 and 11, respectively, had lead concentrations compatible with death from lead poisoning. Taken together, lead concentrations were elevated in liver or kidney samples from 25 eagles and were compatible with death from lead poisoning in 15. Mean bone lead was higher in eagles with elevated hepatic lead than in those exhibiting background hepatic lead concentrations. However, even in the former group, bone lead concentrations were lower than those in lead-exposed individuals of other species of birds. Bone is probably not a useful tissue for identifying elevated lead exposure in eagles. Three of eleven birds that had been shot had anomalous renal lead concentrations, suggestive of contamination by residue from lead ammunition. It is important to exclude such birds when assessing lead exposure.http://link.springer-ny. com/link/service/journals/00244/bibs/37n2p267.html

Animals↗
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↗
PubMed1999

Concept of and preliminary trial protocol for adjuvant treatment of mediastinitis with immunoglobulins after cardiac surgery (ATMI): response to comments and criticism.

During the consensus-based process of protocol development external experts were invited to comment on a proposal for a trial protocol on adjuvant immunotreatment of patients with wound infection after median sternotomy (ATMI). Controversies and arguments can be divided into five main areas: 1) rationale and objectives; 2) criteria for patient selection; 3) adjuvant treatment; 4) measures of efficacy; and 5) course and timetable of the study. We present and summarise the experts comments and criticism as well as the result of the final discussion of the study group with respect to these areas.

APACHE↗
PubMed1999

Preoperative high dose methylprednisolone improves patients outcome after abdominal surgery.

OBJECTIVE: To assess the effect of preoperative high dose methylprednisolone on stress response and outcome. DESIGN: Randomised, placebo-controlled, double-blind study. SETTING: University hospital, Germany. SUBJECTS: 20 patients listed for abdominal surgery of whom 10 had major intra-abdominal interventions and 10 had incisional hernias repaired. INTERVENTIONS: Methylprednisolone 30 mg/kg (100 ml) was given by slow intravenous infusion 90-60 minutes before operation. The control group received the same volume of sodium chloride. MAIN OUTCOME MEASURES: Speed of convalescence, degree of fatigue, amount of pain, consumption of analgesics, breathing capacity, and hospital stay, as well as humoral and cellular mediators of the stress response. RESULTS: Methylprednisolone significantly improved criteria of postoperative recovery, fatigue by 47%, (day 1), convalescence by about 45% (days 1-3), and breathing capacity (FEV1) between 47% and 29% (days 5, 7) (p < 0.05, ANOVA), and led to a significant reduction of median hospital stay of 4.5 days. C-reactive protein concentration was significantly decreased (by 46% on day 3) and T-cell activation was suppressed (day 1). CONCLUSION: Outcome of the patients after conventional abdominal surgery is substantially improved by preoperative high dose methylprednisolone. This effect is more pronounced in patients having major operations.

Adult↗
PubMed1999

Histamine induced homologous and heterologous regulation of histamine receptor subtype mRNA expression in cultured endothelial cells.

Histamine has been proposed to play an important role in early inflammatory responses, based on studies documenting the effects of histamine on vasodilation and permeability of microvascular endothelium, as well as histamine-stimulated neutrophil adhesion to endothelial cells. The complex and heterogeneous biological mechanisms of histamine-mediated responses are not yet completely characterized. One of the factors defining inflammatory responses stimulated by histamine might be the distribution and density of receptor subtypes on cell membranes. The aim of this study was to assess whether the regulation of histamine receptor mRNA levels represents a control point in histamine-stimulated processes. Histamine-induced regulation of histamine receptor subtype expression was studied in vitro by semiquantitative RT-PCR analysis of total RNA extracted from stimulated and unstimulated endothelial cells. The time dependency and extent of histamine induced down-regulation varied between the H1 and H2 receptor message. The rapid decrease of H2 receptor mRNA lasted for 24 h. On the other hand, the less-pronounced reduction of H1 mRNA was transient and returned to control values after 12 h of histamine stimulation. The H2 receptor message was mainly down-regulated by activation of the H1 receptor protein. Down-regulation of the H1 receptor message seemed to be a net result of H1 and H2 receptor activation. This is the first report demonstrating a complex pattern of homologous and heterologous regulation of histamine receptor expression. These findings reveal new insight into the potential diversity of the mechanism involved in processing information via stimulation of multiple G-protein-linked pathways.

Cells, Cultured↗
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

[Effect of pneumoperitoneum on hemodynamics and intestinal integrity in endotoxinemia: CO2 versus helium].

In a study in pigs pathophysiological effects of a pneumoperitoneum (PP) established during endotoxemia (2 micrograms/kg b.w./hr) were investigated. In this situation a PP with carbon dioxide (CO2) or helium induces a deterioration of systemic hemodynamics or acid-base-stability. Some of these effects threaten vital stability. PP with either gas causes a mucosal acidosis of the small bowel within the meaning of an impairment of intestinal oxygen supply. A CO2-PP adversely affects the intestinal energy metabolism and leads to significantly increased endotoxin levels in contrast to helium after desufflation of the abdominal cavity. Data of this study at least demand for a careful monitoring, if laparoscopy is performed in septic and critically ill patients.

Acid-Base Equilibrium↗
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↗