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Biomedical subjects

H P Schuster

Publications and source records attributed to H P Schuster.

At least 19 recordsLinked to original sources
PubMed1995

[Cardioversion in atrial fibrillation. Results and complications in 1,152 prospective patients. Study Group of the Working Society of Leading Cardiologic Hospital Physicians].

BACKGROUND: Pharmacological and direct-current cardioversion of atrial fibrillation are often performed interventions. Little is known about results and complications of cardioversion in daily practise. PATIENTS AND METHODS: Demographic, procedural and outcome data from patients with cardioversion of atrial fibrillation were collected in a prospective, multicenter registry of 61 hospitals. RESULTS: Between July 1994 and December 1994 1152 patients with a mean age of 64 +/- 11 years were registered on an intention-to-treat basis. 62% were male. The most prevalent underlying disorders were coronary artery disease (34.7%), valvular heart disease (18.1%), and cardiomyopathy (6.9%). 16.4% of patients had lone atrial fibrillation. New onset atrial fibrillation was reported in 21%, paroxysmal in 32% and chronic in 47% of patients. The mean duration of atrial fibrillation was 7 +/- 26 weeks (range 1 day to 7 years, median 5 days). In 3.8% of patients no cardioversion attempt was made and follow-up was not possible in another 5.5%. 19.2% of patients cardioverted spontaneously. Direct current cardioversion was attempted in 39.7% and pharmacological cardioversion in 31.8% of patients. Cardioversion was successful (sinus rhythm at discharge) in 96.4% of spontaneous cardioversion, in 73.1% of direct current cardioversion and in 84.4% of pharmacological cardioversion. Success of cardioversion was significantly related to duration of atrial fibrillation, NYHA functional class and left atrial diameter (p < 0.001). In 55 (4.8%) cases complications were reported of which 14 were fatal. Five cases of sudden death occurred, all of which were related to quinidine therapy for pharmacological cardioversion. Five cases of embolism were reported. Two were not associated with cardioversion attempts and 3 occurred within 24 hours after successful direct current cardioversion. Two of these patients were effectively anticoagulated at the time of cardioversion. A total of only 62% of patients with atrial fibrillation of more than 48 hours duration were anticoagulated for cardioversion with coumadine or i.v. heparin. CONCLUSIONS: The main risks of cardioversion are fatal proarrhythmic events in pharmacological attempts to restore sinus rhythm. The risk of embolism is despite low rates of effective anticoagulation low.

Aged↗
PubMed1995

Cloning vectors for the production of proteins in Dictyostelium discoideum.

We constructed and tested a series of cloning vectors designed to facilitate protein production and purification in Dictyostelium discoideum (Dd). These vectors carry the origin of replication of the Dd high-copy-number plasmid Ddp2, expression cassettes consisting of the strong, constitutive actin (act15) or the inducible discoidin (disI gamma) promoters, a translational start codon upstream from a multiple cloning site and sequences for the addition of epitope or affinity tags at the N- or C-termini of any protein. The affinity tag used corresponds to 7 (N-terminal fusion) or 8 (C-terminal fusion) His residues. The epitope tags correspond to an 11-amino-acid sequence from human c-myc, recognised by monoclonal antibody (mAb) 9E10, and the Glu-Glu-Phe sequence recognised by mAb YL1/2 to alpha-tubulin. Both these mAb are commercially available. The YL1/2 epitope offers a second affinity tag for the purification of proteins under native conditions. The functional competence of the vectors was tested by determining their ability to promote the expression of various Dd myosin constructs. High synthesis levels were obtained for each vector; up to 1 mg of homogenous, functional protein per g of cells was obtained after purification of the recombinant products.

Amino Acid Sequence↗
PubMed1995

[Diarrhea, coli infection, septic encephalopathy: escalation of a seemingly banal symptom].

Septic encephalopathy is an early manifestation of sepsis. Changes in consciousness, focal or generalized seizures, multifocal myoclonus and/or varying hemiparesis are common clinical findings. All of these symptoms are reversible when sepsis has been successfully treated. Because there are no generally accepted criteria for the diagnosis of septic encephalopathy, it is a diagnosis of exclusion. We report the case of a 68-year-old patient who developed septic encephalopathy secondary to diarrhea and E. coli sepsis. In this case, symptoms of septic encephalopathy were fully reversed after the patient's E. coli sepsis had been adequately treated.

Aged↗
PubMed1995

[Ethanol ingestion following Antabus overdose: acetaldehyde-induced cardiological emergency].

The differential diagnosis of chest pain is challenging, when the clinical presentation appears pathognomonic, yet conventional diagnostic tests fail to reveal the suspected cause. We report the case of a 38-year-old patient who had an acetaldehyde intoxication (antabuse syndrome) in the setting of disulfiram overdose and ethanol ingestion. The patient presented with severe angina pectoris. Coronary artery disease was suspected, because the patient had risk factors and electrocardiographic repolarization changes were present. During the further investigation it became evident that symptoms were solely caused by acetaldehyde intoxication following disulfiram and alcohol ingestion. Toxic levels of acetaldehyde were found in the patient's serum. Coronary artery disease was ruled out by cardiac catheterization.

Acetaldehyde↗
PubMed1994

[Scoring systems in emergency medicine?].

The primary goals of scoring in emergency medicine are grading of the severity of the patient's condition, measurement of diagnostic and therapeutic efforts, forecasting the outcome, and support in decision making on triage and therapy. Scores can also be used as tools for measuring efficacy and controlling quality. There has been less experience with use of scoring systems to estimate quality of life. The ability to make a prognosis in an individual case is the most critical point; a score may support decisions on therapy in very specific situations only. Scores for use in emergency medicine should be based on physiological parameters, universally applicable and suitable for use throughout the course of diseases. Appropriate score systems are the Glasgow Coma Scale, the Rapid Acute Physiology Score, and the Mainz Emergency Evaluation Score, Trauma Score and Injury Severity Score. Scores suitable for estimation of quality of life following emergencies are the Glasgow Outcome Scale and the Glasgow-Pittsburgh Scale.

Emergency Medicine↗
PubMed1994

Cost containment: Europe. Germany.

The German healthcare system offers a social network guaranteeing almost complete healthcare coverage to the German population (prevention, treatment, and rehabilitation). The system is supported by a multistructured network of public and private healthcare insurers. Fees for public insurance are equally paid by employers and employees. Healthcare expenditures heavily impact the salary levels of employees and, as a result, production costs of employers. About one third of all national healthcare spending goes to hospital care. In 1991, there were ICUs in half of all German hospitals; 3.2% of all hospital beds were ICU beds. As in most countries, the expansion in national healthcare costs in the last decade has become a serious problem in Germany. At total of 8.1% of the entire German gross national product is spent on health care, which has led to drastic governmental healthcare reform that began in 1993. The key points of this reform are: a) strict limitations on hospital budgets at 1992 levels including a new structure of hospital financing; b) controlled reduction of expenditures for medical drugs (which were formerly at the highest level in Europe); and c) controlled restriction of regional distribution for physicians. In a large German university hospital (1,461 beds; 91 ICU beds) expenses for intensive care medicine comprise about 12% of all hospital spending (5,356 deutsche mark/patient). More than 60% of these expenses are for personnel; 37% go toward drugs and medical materials. There are several possible starting points for cost containment in intensive care medicine in Germany: a) a task-adapted, countrywide diffusion of ICUs within the different levels of hospitals; b) a more selective provision of intensive care medicine (primary as well as secondary) to patients, depending on patient needs; c) a centralized and task-oriented admission and discharge policy; and d) cost containment in the use of drug therapy by centralized hospital purchasing and by establishing strict, rational, therapeutic principles. Some examples of the author's personal experience follow. In all German hospitals, expenses for personnel are about 60% to 70%. These expenses are fixed by official, standard wages. Cost containment by further restricting the number of personnel impairs the care provided. Improvements in organization and management may contribute to a higher degree of personal motivation for employees and, in turn, may result in higher working efficiency.

Budgets↗
PubMed1993

Hemodynamic profile of intravenous fenoldopam in patients with hypertensive crisis.

Fenoldopam, a newly developed intravenous dopaminergic DA1 receptor agonist, was used in an open, prospective study for blood pressure control in 12 patients presenting with hypertensive crisis. At a dose of 0.2-0.5 microgram kg-1 min-1 fenoldopam decreased systolic blood pressure from 209 +/- 13 to 151 +/- 17 mmHg and diastolic blood pressure from 114 +/- 10 to 78 +/- 10 mmHg. Blood pressure was controlled in all 12 patients within 5-50 min. In none of the patients did rebound hypertension occur upon termination of the study medication, nor was any adverse event reported. Major hemodynamic changes induced by fenoldopam were a decrease in total peripheral resistance from 1853 +/- 611 to 1193 +/- 368 and in pulmonary vascular resistance from 252 +/- 170 to 180 +/- 74 dyne s-1 cm-5. In patients with high left ventricular filling pressure at study pulmonary capillary wedge pressure decreased while the stroke volume index and mixed venous oxygen saturation increased under fenoldopam. Thus, fenoldopam appears to be a rapid-acting, well-tolerated, and highly effective intravenous substance for the treatment of severe hypertension.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1993

AT III in septicemia with DIC.

In the development of sepsis DIC is a common complication. Several studies presented in this paper show a coincidence between the development of DIC and depletion of Antithrombin III, a serine protease inhibitor which inhibits a large scale of activated clotting factors. It seems very probable that substitution therapy should be of benefit in the treatment of sepsis-related DIC and may improve the outcome of septic patients. Physiological and clinical findings are put together to clarify the basic rationale for running clinical trials and future studies.

Antithrombin III↗
PubMed1993

[Behavior of plasma proteins and nitrogen balance in patients with acute myocardial infarct with and without intravenous amino acid administration].

OBJECTIVE: The goal of this study was to examine the behaviour of nitrogen balance and plasma proteins with or without intravenous supply of amino acids in patients with acute myocardial infarction. DESIGN AND PATIENTS: 30 consecutive patients who suffered from acute myocardial infarction and who were admitted to our medical intensive care unit were examined in an open, non-randomised study. SETTING AND INTERVENTIONS: The first 10 patients (group I) received 10% Intrafusin 10 ml/kg BW/24 h as a continuous intravenous infusion over a period of 96 h. Patients No. 11-20 (group II) received Aminosteril 10% 10 ml/kg BW/24 h also over a 96-hour period. Patients No. 21-30 (group III) were given intravenous infusions of Jonosteril 10 ml/kg BW/24 h for 96 h. RESULTS: The nitrogen balance demonstrated a statistically significant decrease in all groups (group I, 9.1 to 6.1 g/day; group II, 9.8 to 4.8 g/day; group III, 1.3 to -1.1 g/day); however, in groups I and II the nitrogen balance remained positive. The concentrations of total protein, transferrin, retinol-binding protein and pre-albumin decreased significantly. This decrease, however, was significantly less in patients given amino acid infusions. CONCLUSIONS: Infusion of amino acids in acute myocardial infarction results in a positive nitrogen balance and reduces the decrease in plasma protein concentrations. Further studies are required to judge the positive nutritive effect of amino acid infusions on the outcome of myocardial infarction.

Acute-Phase Proteins↗
PubMed1993

[Functional disease pictures without pathologic organ findings--a challenge for the internist].

Many patients suffer from symptoms related to pathomorphologically healthy organs. Typical symptom patterns may be defined as functional disease entities. No demonstrable pathomorphologic alterations mean normal clinical findings, normal results of laboratory tests and function studies, absence of abnormal findings in imaging techniques, and normal results of cytologic or histologic investigations. Symptom patterns of functional diseases are usually impressive and clear, allowing a primary diagnosis, which of cause must be verified by excluding possible differential diagnoses. Early diagnosis has a heavy impact on later course and prognosis. From a certain point of chronicity, functional diseases become more or less refractory to therapy. Neglection of the correct diagnosis may therefore promote chronic disease. The main reason for a misleading diagnosis is the unreadiness of physicians and patients to accept and to face the functional, non-organic nature of symptoms. The main etiologic factor is psychosocial stress in most cases. Treatment is based on four different approaches, which may well be combined with each other: oral communication to clarify and to explain the nature of the disease, changing the all day way of life, supporting drug therapy, and specific psychosomatic treatment.

Adaptation, Psychological↗