Biomedical subjects
Publications and source records attributed to G Pichler.
The aim of this study was to analyse changes in peripheral oxygenation in healthy term neonates within the first week of life with near-infrared spectroscopy and venous occlusion. Oxygen delivery did not change with increasing age. Oxygen consumption and fractional oxygen extraction increased, whereas tissue oxygenation index decreased with increasing age.
For the first time a multimodal approach to NEC prophylaxis is reported, consisting of early trophic feeding with human breast milk, and enteral administration of an antibiotic, an antifungal agent, and probiotics. A retrospective analysis of local protocol of NEC prophylaxis is presented. Included were all VLBWI admitted to the NICU, including transfers within the first 28 days of life. These infants were divided into two groups, an "inborn group" (infants admitted within the first 24 h of life) and an "outborn group" (infants admitted after the onset of their second day of life). Prophylaxis of NEC according to protocol was started at the day of admission, and was continued until discharge. Between 1998 and 2004, 405 VLBWI were admitted, including all transfers within the first 28 days of life. A total of 334 (82%) infants were admitted within the first 24 h of life (inborn group), and 71 (18%) were admitted after 24 h of life (outborn group). Five infants developed clinical features of necrotizing enterocolitis. The inborn group showed a NEC incidence of 0.7% (two infants), whereas the outborn group showed a NEC incidence of 4.5% (three infants), respectively. This difference was significant (P=0.049, Fisher's exact test). A surgical treatment with bowel resection was performed in two infants (both from the outborn group). The present study used a combination of different strategies, all having shown to have some beneficial effect, but not having brought a clinical breakthrough in single administration studies. Combinated were the beneficial effects of human breast milk feeding, oral antiobiotics, oral antifungal agents, and the administration of probiotics. In a homogenous group of preterm infants, using this protocol of multimodal NEC prophylaxis, there was a very low incidence of NEC, when started within the first 24 h of life.
UNLABELLED: The assessment of forearm oxygen consumption (VO(2)) and forearm blood flow (FBF) by means of near infrared spectroscopy has become widespread in adults, whereas in children and adolescents no data are available. The aim of the present study was to analyze VO(2) and FBF in healthy children and adolescents. METHODS: In a prospective cohort study, 20 male and 20 female healthy children and adolescents were investigated. The measurements of VO(2) and FBF were performed by means of near infrared spectroscopy in combination with the venous occlusion method. RESULTS: Mean VO(2) was 0.08 +/- 0.04 ml 100 g(-1) min(-1) in male and 0.09 +/- 0.05 ml 100 g(-1) min(-1) in female subjects. Mean FBF was 1.95 +/- 1.25 ml 100 g(-1) min(-1) in male and 1.82 +/- 0.98 ml 100 g(-1) min(-1) in female subjects. No significant difference was found between male and female subjects. A significant negative correlation of VO(2) and FBF to age was observed in both groups. CONCLUSION: In the present study we were able to show that VO(2) and FBF decreased with increasing age in children and adolescents without significant differences between male and female subjects.
Visible absorption spectra of cesium-doped helium nanodroplets between 14,500 and 17,600 cm(-1) were probed by laser-induced fluorescence. A strong absorption band peaking around 16,700 cm(-1) is identified as Cs2 1(a) 3Sigmau+-3 3Sigmag+ transition. A broad unstructured band near 17,520 cm(-1) is assigned as the Cs2 1(X) 1Sigmag+-2 1Sigmau+ transition. Explanations of the observations are discussed on the basis of ab initio potential curves calculated by Spies and Meyer [(unpublished)]. All spectra have been modeled using narrow Frank-Condon windows around the equilibrium internuclear distance of the lowest singlet and triplet states. Many observed absorption peaks of smaller intensities could be identified, some of which may be due to transitions of cesium trimers formed on the droplets.
We present direct observation of the velocity-selective optical pumping of the Rb ground state hyperfine levels induced by 5S(1/2) --> 5P(1/2) femtosecond pulse-train excitation. A modified direct frequency comb spectroscopy based on the fixed frequency comb and a weak cw scanning probe laser was developed. The femtosecond pulse-train excitation of a Doppler-broadened Rb four-level atomic vapor is investigated theoretically in the context of the density matrix formalism and the results are compared with the experiment.
The unavoidable consequence of composite resin photopolymerization is temperature rise in tooth tissue. The temperature rise depends not only on the illumination time, but also on light intensity, distance of light guide tip from composite resin surface, composition and shade of composite resin and composite thickness. The most commonly used units for polymerization today are halogen curing units, which emit a large spectrum of wavelengths. A proportion of the spectrum has no influence on degree of conversion and therefore causes unnecessary temperature rise. Units based on light source - blue light emitting diodes (LED), as an alternative for halogen curing units, have been introduced in clinical practice. The aim of this study was to show the influence of the light intensity of curing units Elipar Trilight, Astralis 7 and Lux-o-Max unit on temperature rise in composite resin sample of Tetric Ceram. The temperature was measurement with Metex M-3850 D multimeter with the tip of temperature probe put into unpolymerized composite resin sample 1 mm depth. The highest temperature rise was recorded with standard curing mode for Elipar Trilight halogen curing unit (13.3 +/- 1.21 degrees C after 40 s illumination), while the lowest temperature rise was recorded for the Lux-o-Max unit based on LED technology (5.2 +/- 1.92 degrees C after 40 s illumination).
OBJECTIVE: To determine the clinical presentation and aetiology of small subcortical infarctions as found on diffusion weighted magnetic resonance imaging (DWI). DWI is both sensitive and specific in the early detection of acute ischaemic brain lesions irrespective of pre-existing vascular damage. METHODS: Ninety three patients were identified showing subcortical or brainstem DWI lesions <1.5 cm in diameter within a maximum of 7 days from the onset of stroke symptoms. The patients' clinical status on admission was reviewed according to the Oxfordshire Community Stroke Project (OCSP). The results of procedures searching for cerebrovascular risk factors, large artery disease, and potential sources of cardiac embolism were included to determine stroke aetiology. Magnetic resonance imaging scans were also reviewed for concomitant changes that could support the aetiologic classification. RESULTS: Only 41 (44.1%) patients presented clinically with a lacunar syndrome according to OCSP criteria. The nine (9.7%) patients who showed two or more DWI lesions in different vascular territories were also significantly more likely to have potential sources of cardiac embolism (5/9, 55.6% v 20/84, 23.8%). Hypertension was significantly more prevalent in the group of patients who showed a microangiopathy related imaging pattern, but this pattern did not exclude the presence of large artery disease or a possible cardioembolic source of stroke. CONCLUSION: Identification of small subcortical infarctions as the cause of stroke appears quite uncertain based on clinical characteristics only. DWI adds significant aetiologic information but does not obviate the search for other potentially causative mechanisms.
Arthralgia in childhood is an unspecific symptom. One rare cause of arthralgia is hypertrophic osteoarthropathy associated with digital clubbing. We present a child where hypertrophic osteoarthropathy led to the rare diagnosis of an inflammatory pseudotumour of the lung. In a 12-year-old girl with arthralgia and digital clubbing, a chest radiograph disclosed a large round mass in the right upper lobe, and the following chest computed tomography scan showed a large solid homogenous, round, well marginated lesion with little contrast enhancement. A lobectomy of the right upper lobe was performed, and histological examination showed an inflammatory pseudotumour. The postoperative course was without problems: arthralgia and digital clubbing disappeared.
AIM: Measurement of cerebral haemodynamics to detect impaired cerebral blood flow and impaired cerebral autoregulation might make prevention of brain lesions and especially periventricular leucencephalomalacia (PVL) achievable. METHODS: Changes in cerebral blood volume (CBV) and the cerebral haemoglobin oxygenation index (cHbD) following tilting up and down in 10 preterm infants with PVL and 25 preterm infants without PVL, measured by near infrared spectroscopy (NIRS), were analysed. Tilting manoeuvres were recorded with a polysomnographic system in combination with NIRS. CBV and cHbD of the baseline phase (1 min before tilting) were compared with data from the post-tilting phase (1 min after tilting). RESULTS: Changes in CBV and cHbD after tilting were significantly pronounced in infants with PVL compared with infants without PVL. CBV decreased in infants with PVL, by -0.099 +/- 0.081 ml 100 g(-1) brain (mean +/- SD) after tilting up, and increased by 0.106 +/- 0.104 ml 100 g(-1) brain after tilting down. CBV decreased in infants without PVL, by -0.041 +/- 0.068 ml 100 g(-1) brain after tilting up, and increased by 0.020 +/- 0.096 ml 100 g(-1) brain after tilting down. cHbD showed similar changes after tilting. CONCLUSION: Changes in CBV and cHbD after tilting were pronounced in preterm infants with PVL and this may indicate reduced cerebral autoregulatory capacity.
The objective of this study was to evaluate the degree of conversion and temperature rise in three different composite materials when illuminated by an experimental light source [blue superbright light emitting diodes (LEDs)] and compared with plasma light and traditional photopolymerization unit. The degree of conversion and temperature rise were measured using Fourier transform infrared (FTIR) spectroscopy and digital multimeter, respectively. The results revealed significantly higher degree of conversion values in case of conventional curing than with other two light sources whereas temperature rise was significantly lower when blue LEDs and plasma light were used. There were great differences in light intensities between blue LEDs of only 9 mW cm-2 compared with plasma light of 1370 mW cm-2 and Elipar II of 560 mW cm-2. Better match of LED spectral distribution peak to camphorquinone absorption distribution peak probably explains much lower intensities used for similar photopolymerization effect like in the case of rapid plasma lamp curing.
Everyday improvements in components and characteristics of composite materials have induced faster development of curing units. Besides standard halogen curing units and soft-start photopolymerization light sources, some experiments with argon and pulsed laser light and low intensity blue superbright light emitting diodes have been made. On the other hand, rapid polymerization with strong plasma light is also clinically applicable. The aim of this study was to measure the degree of conversion and temperature rise for three restorative composite materials: Tetric Ceram (Vivadent, Schaan, Liechtenstein), Pertac II (ESPE, Seefeld, Germany) and Z100 (3M Dental Products, St Paul, MN, USA) during polymerization with plasma light Apollo 95E (DMDS, Dental/Medical Diagnostic Systems, Fleury d'Aude, France) and compare it with the results of polymerization with a halogen curing unit, Elipar Trilight (ESPE, Seefeld, Germany). The results revealed the degree of conversion values in the case of polymerization with plasma light to be almost equal to those obtained by curing with the halogen curing unit, whereas the temperature rise was almost negligible.
This paper reveals the results of synchronized intermittent mandatory ventilation in premature babies over a period of 8 years. Out of 1532 mechanical ventilated newborns 438 were prematures with severe hyaline membrane disease. The incidence of barotraumatic complications (Pneumothorax 1.2%, pulmonary interstitial emphysema 3% and bronchopulmonary dysplasia 3.4%) was relatively low. We discuss this as an effect of using low respirator frequencies guaranteering sufficient emptying time of the lungs.
The objective of the present study was to evaluate sleeping position-dependent effects on cerebral hemodynamics during apnea in preterm infants. To this end, polygraphic studies were performed on 15 stable preterm infants lying prone and lying supine. Changes in cerebral blood volume (DeltaCBV) and in cerebral hemoglobin oxygenation ((Delta)cHbD) in association with apnea were measured by near infrared spectroscopy. For comparison, apnea in the prone position was matched for duration to apnea in the supine position. A total number of 98 pairs of apnea were compared. The mean duration of apnea was 8.2+/-3 s. In both positions there was a predominance of decrease in CBV and cHbD in association with apnea. The mean decrease of cHbD (-1.57+/-1.82 micromol/l) and of CBV (-0.120+/-0.137 ml/100g brain) in the supine position was significantly pronounced compared to prone position (DeltacHbD: -1.18+/-1.77 micromol/l, DeltaCBV: -0.080+/-0.095 ml/100 g brain). The degree of DeltaCBV and DeltaHbD did not correlate with postconceptional or postnatal age (r2<0.01). In both positions there was a similar small decrease of SaO2 in association with apnea. In the supine position heart rate decreased slightly during apnea, whereas in the prone position no change in heart rate could be observed. The present study revealed a position-dependent different impact of apnea on cerebral hemodynamics. With regard to cerebral blood volume and oxygenation in association with apnea no negative effects of prone sleeping position could be observed in preterm infants.
To ensure an adequate clinical composite filling light source for photopolymerization is of great importance. In everyday clinical conditions commonly used unit for polymerization of composite material is halogen curing unit. The development of new blue superbright light emitting diodes (LED) of 470 nm wavelengths comes as an alternative to standard halogen curing unit of 450-470 nm wavelengths. The purpose of this study was to compare the degree of conversion (DC) and temperature rise of four hybrid composite materials: Tetric Ceram, Pertac II, Valux Plus and Degufill Mineral during 40 s illumination with standard halogen curing unit Heliolux GTE of 600 mW cm(-2) intensity, Elipar Highlight soft-start curing unit of 100 mW cm(-2) (10 s) and 700 mW cm(-2) (30 s) intensity and 16 blue superbright LED of minimal intensity of 12 mW cm(-2) on the surface and 1 mm depth. The results revealed only a little bit higher DC values in case of polymerization with even 66 times stronger halogen curing units which showed twice higher temperature than blue diodes. Temperature and DC obtained are higher on the surface than on 1 mm depth regardless on the light source used.
Tilting is known to cause changes in hemodynamics due to hydrostatic pressure. The present study is an analysis of changes in cerebral hemodynamics measured by near infrared spectroscopy (NIRS) following tilting up and down in preterm and term infants. A significantly different effect of tilting up in comparison to tilting down on total hemoglobin in preterm infants and on the 'hemoglobin oxygenation index' in preterm and term infants was observed. In preterm infants, tilting up and down had a significantly different effect on cerebral blood volume (CBV), with an increase after tilting down and a decrease after tilting up. In term infants, tilting had no significant effect on CBV comparing these two procedures. We think that NIRS provides a good method to measure cerebral hemodynamics following tilting, whereby different reactions in infants of different postconceptional age can be observed.
Vitamin K prophylaxis usually is administered orally or intramuscularly, but in neonatal intensive care oral administration might not be feasible and intramuscular administration is not general practice in very small infants. No data are available about plasma levels after intravenous administration of vitamin K to neonates. Therefore, we investigated plasma levels in 18 infants: 14 preterms with a birthweight of 1785+/-648 g and 4 sick newborns with a birth-weight of 3167+/-510 g after administration of a single dose of 0.3+/-0.1 mg/kg phylloquinone (vitamin K(1)) (Konakion MM((R)), Roche) intravenously after birth. Blood was collected 22.9+/-18.4 hours after intravenous administration of vitamin K(1). In 10 neonates a second sample was obtained 111.8+/-49.1 hours after the first vitamin K(1) administration. Gas chromatography-mass spectrometry (GC-MS) was used as the method for determination of vitamin K(1). The measured plasma concentration after intravenous administration of vitamin K(1) was 191.3+/-102.6 ng vitamin K in the first sample /mL in the first sample and 98.7+/-75.2 ng vitamin K(1)/mL in the second samples. These results are similar to those described in newborns after oral administration of 3 mg vitamin K(1) and after intramuscular administration of 1.5 mg vitamin K(1). In conclusion, the recommendation of the producer to give 0.4 mg/kg of vitamin K intravenously to neonates, in whom oral or intramuscular administration is not feasible, seems to be rational.
The present study is an analysis of changes in cerebral oxygenation and cerebral blood volume (CBV) during periodic breathing in healthy term infants by means of near infrared spectroscopy (NIRS). Polygraphy included electrocardiogram, electrooculogram, heart rate, oxygen saturation, side stream capnography, two respiratory effort sensors, a movement sensor, and NIRS. During periodic breathing analysis of behaviour of total haemoglobin (cHbtot), deltaCBV, the haemoglobin oxygenation index (cHbD), and cytochrome oxidase (CytOx) was performed. In ten healthy term infants 30 cycles of periodic breathing with a mean of 10 apnoeas per cycle were analysed. Corresponding cyclical variations of cHbD appeared in 98%, cyclical variations of cHbtot appeared in 42% of all apnoeas. During phases of apnoea, a mean decrease of cHbD of -3.45 micromol/l occurred 1.75 seconds after onset of apnoea, and a mean decrease of cHbtot of -0.79 micromol/occurred 0.74 seconds after onset of apnoea. During these apnoeas, the deltaCBV was -44 microl/100 g brain. During phases of ventilation, there was an increase of cHbD and cHbtot to the pre-apnoeic levels. There was a tendency that CytOx values decreased during periodic breathing, the amount of decrease was -0.32 micromol/l. In conclusion, the present study was able to show for the first time that there is cyclical desaturation and reoxygenation of cerebral blood during periodic breathing. Cyclical changes in CBV in association with periodic apnoea occurred only in 42% of apnoea.
The aim of this study was to analyse the behaviour of cerebral oxygenation and cerebral blood volume (CBV) in preterm infants during apnoea by means of near-infrared spectroscopy (NIRS). The sum of oxygenated and deoxygenated haemoglobin, the total cerebral haemoglobin (Hbtot) corresponds to CBV, whereas the difference of oxygenated minus deoxygenated haemoglobin (HbD) represents a value for cerebral oxygenation. During 2 hours of daytime sleep, 72 polygraphic tracings (including NIRS) were done in 58 premature infants. The main criteria for study entry were clinically evident episodes of apnoeas and prematurity. According to their length, apnoeas were divided into two groups: apnoeas of 5-14 seconds (Group 1) and apnoeas > or = 15 seconds (Group 2). Periodic breathing was excluded from analysis. A total number of 1345 apnoeas in Group 1 and 74 apnoeas in Group 2 were recorded, 647 (46%) fulfilled criteria for further analysis. We observed different patterns of CBV behaviour, but the majority, namely 94% in Group 1 and 87% in Group 2, showed a decrease of CBV during apnoea. There was always a cerebral deoxygenation (decrease in HbD) in association with apnoeas, which was significantly increased in apnoeas of longer duration.