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Biomedical subjects

E Neugebauer

Publications and source records attributed to E Neugebauer.

At least 109 records · Page 6Linked to original sources
PubMed1995

[Mediator systems and infection].

Sepsis is the systemic response of the body to an infection. Sepsis-like conditions with nearly identical body reactions, however, are also seen without any evidence of bacteremia. Sepsis is a disease of the host response (specific and non-specific immune system). Depending on the time of the disease process, different mediators (released or newly formed) are involved. This review summarizes the current knowledge and interactions of different cells, cascade systems and mediators in the pathogenesis of sepsis and gives an overview of the approaches and results of current "anti-mediator strategies" to control or modulate inadequate mediator responses.

Acute-Phase Reaction↗
PubMed1994

Technology assessment of endoscopic surgery.

Endoscopic surgery is considered a milestone in the evolution of surgical technique in nearly all fields of surgery. However, the inappropriate use of the new technology in medicine has also been heavily criticised. Systematic technology assessment of endoscopic surgical techniques is mandatory to prove the real benefits and complications, so defining the indications for their appropriate use. This article describes methods of technology assessment suitable for endoscopic techniques with emphasis on relevant endpoints for surgeons and patients. The general stages of a comprehensive technology assessment include: 1. feasibility (safety and technical performance) 2. efficacy (patient benefits in pioneering places) 3. effectiveness (patient benefits in average hospitals in the community as a whole) and 4. economic evaluation (cost-benefit analyses). We used the example of laparoscopic cholecystectomy to describe the methods of technology assessment. A cohort study on 500 patients revealed that laparoscopic cholecystectomy is as safe as the conventional standard open technique. The results on efficacy strongly support the hypothesis of more comfort and less trauma with the endoscopic technique. Major endpoints evaluated were postoperative pain, convalescence, fatigue and quality of life. Data on effectiveness and economics are still in a "premature" state and should be the subject of further analyses. It is concluded, that other disciplines such as neurosurgery should evaluate their endoscopic surgical techniques according to the rules of technology assessment outlined in this paper.

Cholecystectomy, Laparoscopic↗
PubMed1994

Pain after laparoscopic cholecystectomy. Intensity and localization of pain and analysis of predictors in preoperative symptoms and intraoperative events.

It is postulated that laparoscopic cholecystectomy as "patient-friendly surgery" leads to more comfort and in particular to less pain. A prospective study on pain was performed on all patients undergoing the operation over the period of 1 year (n = 382) out of a series of more than 1,000 patients who have undergone the operation in our clinic. Pain was measured by a 100-point visual analogue scale (VAS), by a five-point verbal rating scale, and by the consumption of analgesics. Pain was the most frequent symptom, both before and after the operation. The mean level of pain was 37 VAS points 5 h after the operation and declined to 16 points on the third day. In 106 patients (27.8%) the intensity of pain was higher than 50 VAS points. Analgesics were used by 282 patients (73.8%), opioids by 112 (29.3%). Pain was significantly higher in female than male patients (P < 0.05), but consumption of analgesics was similar in both groups. The most severe pain was localized to the abdominal wall wounds by 157 (41.1%) and to the right upper abdomen by 138 patients (36.1%) on the first postoperative day. Patients who needed opioids and/or had a pain level of > 50 VAS points (n = 138) had higher preoperative pain levels (P = 0.018) and preoperatively complained more frequently about nausea, vomiting, bloating, and a feeling of abdominal pressure (P = 0.003-0.031). However, predictive values of these variables were too small to be of clinical benefit.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Pain↗
PubMed1994

[Trauma and circulatory arrest. 224 preclinical resuscitations in Cologne in 1987-1990].

Posttraumatic cardiopulmonary resuscitation (CPR) is associated with a poor outcome. When evaluating the literature according to the Utstein method, there were only 2 survivors (0.18%) out of 1,135 CPR attempts after trauma (Table 1). Differences in the study populations and levels of prehospital trauma care led us to analyse the results of a physician-staffed prehospital trauma care system in Cologne. METHODS. From January 1987 to December 1990, a total of 49,054 emergency calls were registered using a standardised protocol. Among 9,595 trauma-related calls, 636 patients were found to be pulseless on arrival of the emergency team, 412 of these were pronounced dead. CPR was initiated in the remaining 224 patients, who comprise the study population (defined as 100%). All patients who were admitted to a hospital were followed using a second protocol. RESULTS. CPR in the field was successful in 68 (30.4%) patients, who were then admitted to a hospital; 42 of these died within the first 24 h. Four patients (1.8%) could be discharged from hospital alive and were still living 1 year later, 1 with a lasting neurological deficit (Fig. 1). In 156 (69.6%) cases resuscitative attempts were unsuccessful in the field. CONCLUSIONS. Even in a physician-staffed prehospital trauma care system, the chance of surviving a posttraumatic cardiac arrest is minimal. Survival has to be regarded as an individual fate; the overall results are discouraging. Even though this study analyses the largest population of posttraumatic CPR ever published, prognostic factors could not be identified due to the few survivors. Nevertheless, the result does not justify general omission of CPR after trauma as: (1) prognostic factors for survival have not been identified thus far; and (2) no significant additional costs arise from posttraumatic CPR.

Adult↗
PubMed1994

Histamine synthesis and content in benign and malignant breast tumours. Its effects on other host tissues.

We studied 100 patients: 40 with breast cancer, 41 with benign breast tumours and 19 non-cancer-bearing cholecystectomy patients, in order to measure the histidine decarboxylase activity and histamine content in benign and malignant breast tumours, and to determine whether the histamine metabolism affected skin and muscle tissue distant from the tumour. The HDC-activity of cancerous tissue was significantly higher (P < 0.01) than that registered in the healthy mammary gland tissue of the same patient, being even more pronounced in benign tumour tissue (P < 0.001). However, the histamine content was found to be significantly lower (P < 0.01) in malignant tumours, but higher in benign tumoural tissue as compared with the healthy tissue of the same patient. We also found that the histamine content in muscle tissue was significantly higher in cancer patients than in non-cancer patients. These findings highlight the fact that intracellular histamine metabolism varies in benign and malignant tumours, and that high histamine synthesis of malignant tumours affects other host tissue.

Breast↗
PubMed1994

Time sequence of histamine release and formation in rat endotoxic shock.

Increased histamine release and formation (induced histamine) are two hypotheses considered in the pathogenesis of endotoxic shock development. To prove both hypotheses a sequence of four randomized controlled studies in rats was performed. Histamine release was measured indirectly as a decrease in tissue-histamine contents (lung, liver, spleen, stomach); histamine formation was estimated directly as an increase in histidine decarboxylase (HDC) activity in the same organs. Changes in contents and enzymatic activities were determined 4 and 8 h after shock induction; in addition, at the time of death, the activity of HDC was measured in heart, kidney, and small intestine. 4 h after shock induction, there was a significant decrease in the tissue-histamine content as measured only in the liver, with the same trend in lung and spleen. 8 h after endotoxin application, however, histamine concentration increased in the liver (significantly p < .05) and lung compared to the NaCl control group. The manifestation of changes in HDC activity in various organs was selective (i.e., not all organs showed alterations), not uniform (decreased as well as increased activities were measured), and time-dependent (no increase in HDC activity in animals dying at > 20 h). At 4 and 8 h, only the liver showed a strong increase in HDC activity which can explain the increase in histamine content. In lung, spleen, and stomach, a significant decrease occurred. The results on histamine release and formation let us conclude that histamine is involved in the pathogenesis of endotoxic shock development.

Animals↗
PubMed1994

Beneficial effect of H2-agonism and H1-antagonism in rat endotoxic shock.

Although histamine release is generally considered harmful in endotoxic shock, several data exist to doubt this view. Own previous studies in rats let us assume a possible beneficial effect only with H1-antagonists, however a detrimental effect on survival with H2-antagonists. Consequently H1- and H2-agonists and antagonists were studied to prove the hypothesis of a beneficial H2-agonistic and H1-antagonistic effect. Two randomized studies were performed in a standardized rat endotoxic shock model (45 mg of Escherichia coli endotoxin/kg body weight (b.w.)). In both, methylprednisolone (50 mg/kg b.w.) and saline were used as positive and negative controls, respectively. Study I compared the effects of H1- and H2-agonists (betahistine, .1 mg/kg/h, and impromidine, 100 micrograms/kg/h) with H1- and H2-antagonists (astemizole and famotidine both 1 mg/kg b.w.; 20 rats/dose). Study II was performed to estimate the dose-response relationship of a new, highly potent H2-agonist with additional H1-antagonistic features (BU-E 75: .01, .1, 1.0, 10, and 100 micrograms/kg/h; 20 rats/dose). Animals receiving impromidine or BU-E 75 all received omeprazole (1 mumol/kg b.w.) to suppress gastric acid secretion. In study I impromidine significantly increased the survival-time and -course compared to famotidine treated animals (p = .01 and p < .05). Study II showed a positive dose-response relationship of BU-E 75 with an increase in survival rates from 30% (.01 microgram/kg/h) to 70% (100 micrograms/kg/h). These data strongly support the hypothesis of a beneficial effect of H2-agonism and H1-antagonism on survival parameters in rat endotoxic shock.

Animals↗
PubMed1994

[Laparoscopic or classical appendectomy? A prospective randomized study].

Though laparoscopic appendectomy started endoscopic surgery in general surgery, it has yet not reached the acceptance as is the case with cholecystectomy. The application of this technique in possibly bland appendices and reports that the technique was accompanied by severe complications, increases the scepticism about it. This made us decide to start a randomized controlled trial: laparoscopic vs. conventional appendectomy. More than 1000 endoscopic interventions mainly performed at the gallbladder and the stomach and 165 prospectively documented and partly treated patients with acute appendicitis were the basis to start this trial. "Acute Appendicitis" was diagnosed on the basis of clinical symptoms by means of the computer-aided questionnaire of the EC-study "Acute Abdominal Pain", a self-developed validated diagnostic score, the macroscopic findings and the careful assessment of the histology of the resected appendix. Beside the technical feasibility, principle end-points were mainly intensity and course of postoperative pain measured by means of the Visual Analogue Scale (VAS) in lying, standing and moving position and the postoperative consumption of analgesics. We assessed a difference of 15 points on the VAS as clinically relevant. Of 57 patients with acute appendicitis we performed open appendectomy in 23 and laparoscopy in 34 patients according to randomization. In 9 patients of the laparoscopy group it was necessary to change over to open appendectomy for different reasons resulting in a direct comparison of 25 laparoscopies versus 23 open appendectomies. There were no differences between sociodemographic and preclinical data in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

[What is the value of score systems?].

Numerous scoring systems are available for various particular situations. Some clinicians consider scores as mandatory for daily clinical decision making, while others see them only as additional work with no proven benefit except for scientific aspects. Although scoring systems have their limitations, they can also be of value. This article provides an overview of existing systems used in emergency and intensive care medicine. The specific aims of different scoring systems are discussed and evaluated for the areas of disease classification, monitoring of individual patients and applications to individual decisions, quality assurance (comparison of patient groups and therapies), economic evaluation and global triage decisions. Despite the additional workload it is concluded that scoring systems are of proven benefit for classification of the degree of severity of a disease process, quality assurance, and better assessment of costs containment. These instruments will become increasingly important in our current discussion on changes in health care systems.

Humans↗
PubMed1994

[Quality assurance in the management of severely ill patients: how can score systems help?].

Quality control requires the definition of a quality standard, followed by quality documentation and comparison. In the case of deviation from the standard, the first step in quality assurance is the search for the reasons. After identification of weak points, strategies for quality improvement must then be developed and implemented. With prehospital trauma care as an example, a practical model of quality assurance is presented. Data analysis was performed using the prospective database of 8792 trauma patients who received prehospital trauma care in Cologne from 1. 1. 87 to 31. 12. 90. The Trauma Score was used for classification of the severity of injury. The quality standard in prehospital treatment of severely injured patients is defined as institution of an intravenous line, early intubation and transportation to a trauma centre. The time at the scene of the accident should not exceed 31 min. Among the 8792 trauma patients, 834 had severe injuries, defined as a Trauma Score equal to or less than 12 or a Glasgow Coma Scale equal to or less than 7. An intravenous line was started in 91.6%, early intubation was performed in 82.7%, and transportation to a trauma centre was realized in 62.5% of the patients. The average time at the scene was 34 min. Obviously the standard was not always achieved. Reasons for deviation from the standard are discussed. The fascinating aspect of the model proposed is that it enables quality assurance of prehospital treatment without recourse to hospital data.

First Aid↗
PubMed1994

[Instruments for measuring the quality of life of severely injured patients].

Trauma can be defined as either a somatic injury or a psychological reaction in the person affected. The emotional disturbances and psychosocial problems of trauma patients in particular, though still measurable a year or even longer after the event, have rarely been taken into account in surgical studies. Quality of life is a relevant endpoint in multiple trauma patients, insofar as rehabilitation seems to be complicated by non-efficient psychological coping. With reference to the prerequisites for a scientifically sound measuring method four instruments are described that seem to be suitable for measuring quality of life in multiple trauma patients. In addition, practical advice is given for the design of longitudinal studies focused on quality of life in trauma patients.

Activities of Daily Living↗
PubMed1993

[Patient-controlled analgesia (PCA) for postoperative pain relief. A prospective observational study for evaluating the technology in a ward routine].

Patient-controlled analgesia (PCA) is rarely used on surgical wards despite described advantages of this method as compared to conventional techniques. Uncertainties in patient selection and insufficient evaluation of this technique may explain these circumstances. The aim of our study was to evaluate PCA on general surgery and traumatology wards by means of standardized criteria for technology assessment (i.e. safety, practicability, benefit for patients and medical staff) and the efficacy of pain relief. In a prospective study we investigated 120 patients. In phase I, we performed analgesic therapy with tramadol/metamizol (50 ASA status I-IV patients). In phase II, piritramid had been applied to 70 ASA status I-II patients after an intermediate analysis of phase I. In 7% of the patients technical problems led to an early interruption even at the end of the study period. There were, however, no incidents which caused vital problems for the patients. A mean postoperative pain level of 55 visual analogue scale points (0-100 point scale) was achieved with tramadol/metamizol. PCA was stopped in 16% of the patients due to the occurrence of nausea or vomiting and in two patients due to insufficient pain relief. The use of piritramid in phase II led to lower pain levels and no interruptions of PCA because of ineffectivity or nausea/vomiting.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[The incidence of postoperative pain on general surgical wards. Results of different evaluation procedures].

Knowledge of the incidence and significance of postoperative pain is essential for the establishment of effective pain treatment programmes. Detailed investigations on the incidence, severity and quality of postoperative pain from the surgeon's perspective are scarce in German hospitals. It was the aim of our study to investigate postoperative pain in general surgery under routine conditions. PATIENTS AND METHODS. A total of 168 patients scheduled for abdominal, vascular and orthopaedic surgery were investigated in a prospective trial. Pain was assessed by means of a 100-point visual analogue scale (VAS), a 5-point verbal rating scale (VRS), the original version of the McGill Pain Questionnaire (MPQ) and the short form of the McGill Pain Questionnaire (SFMPQ). These were applied preoperatively and daily thereafter up to the 7th postoperative day. Patients were randomly assigned into two groups with different sequences of application of the instruments. The pain treatment programme included intravenous analgesia with tramadol/metamizol (max. tramadol 400 mg+metamizol 5 g in any 24 h) after major surgery and additional administration of piritramide as needed (max. 60 mg/24 h.i.v.). After minor surgery ibuprofen was routinely given for analgesia (3 x 500 mg). RESULTS. All patients had pain on the days 1 and 2 postoperatively. The mean intensity of pain was 44 VAS points on day 1 and 6.8 points on day 7. The mean intensity of pain measured by the VRS on the 1st postoperative day was between "mild" and "moderate". The quality of pain showed a constant pattern concerning the mean scale values of descriptors of each subgroup (sensory, evaluative, affective, mixed) for both the original and the short form of the McGill Pain Questionnaire up to the 7th postoperative day. Sensory descriptors were reported more frequently than affective descriptors. Typical pain patterns were identified for different operations. After subtotal thyroidectomy, for example, patients perceived a high intensity of pain of short duration. In contrast, patients still have a high intensity of pain up to 7 days after abdominal and rectal operations. CONCLUSIONS. We conclude from our results that patients perceive significant postoperative pain under current standardized pain treatment in our department. Effective programmes for pain relief should take account of the different patterns of pain after different operations, as identified in this study.

Adolescent↗
PubMed1993

[Trauma score systems as instruments in quality control. A prospective study on validation of 7 trauma score systems with 612 trauma patients].

Quality control in the treatment of trauma patients often consists in comparisons of survival rates. The trauma population under study is seldom defined with regard to severity of injury. Therefore crude survival rates are of little help when the quality of care is discussed. Trauma scores attempt to summarize the severity of injury of trauma patients in a single number. They attempt to translate differences in the severity of injury into a common language. This study tested the validity of seven common trauma score systems in the setting of Cologne in 1987. Six hundred and twelve trauma patients treated by physicians at the scene of the accident were prospectively followed up in 32 hospitals. Final diagnosis, treatment, complications, and survival were evaluated. Sensitivity and specificity in predicting survival were calculated for the following systems: Glasgow Coma Scale, Trauma Score, Revised Trauma Score, Injury Severity Score, TRISS, Prehospital Index, Polytraumaschlüssel. The average time from emergency call to arrival of the emergency physician at the scene of the accident was 6.5 min. Four hundred and one patients (65.5%) were male. One hundred and thirty-seven patients (22.4%) suffered from apnoea, 61 (10.0%) had a systolic blood pressure lower than 90 mmHg, 117 (19.1%) had had a cardiac arrest and 174 (28.4%) were unconscious. Four hundred and twenty-three patients (69.1%) left hospital alive. All trauma score systems tested showed sensitivities and specificities greater than 83%. They all proved their ability to classify trauma patients according to severity of injury. The TRISS performed best of all, with sensitivity of 93.1% and specificity of 93.7% at a cut-off point of 0.85.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1993

[The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery].

Since the measurement of quality of life is a relevant endpoint of patient assessment, an international team of methodologists and surgeons have developed a new system-specific index. In different phases, items were collected, tested, rejected or retained and finally verified by international experts. The instrument was also validated against other generic measures, it was compared to 150 normals, tested for reproducibility with 50 stable patients and for responsiveness with 159 patients undergoing laparoscopic cholecystectomy. The product is a bilingual (German and English) questionnaire containing 36 items. Although further testing is in order, we conclude that the Gastrointestinal Quality-of-Life Index is ready to be used in clinical practice and research.

Activities of Daily Living↗