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Biomedical subjects

H Schilling

Publications and source records attributed to H Schilling.

114 records · Page 7Linked to original sources
PubMedDate not supplied

Solutions for APD: special considerations.

Automated peritoneal dialysis (APD) has become the fastest growing dialysis modality in Europe and the United States in recent years. Freedom from daytime exchanges, flexibility of prescription, performance in recumbent position leading to enhanced treatment efficacy, and a decreased incidence of peritonitis are the main advantages of APD over CAPD. Studies on new developments of glucose-based PD fluids were performed predominantly in CAPD patients. High volumes and frequent APD cycles in patients may aggravate the adverse effects of standard CAPD fluids on the peritoneal membrane with increasing time on PD. New, glucose-based PD fluids with neutral pH, very low concentrations of glucose degradation products (GDPs), containing either lactate or bicarbonate as buffering substances have been introduced into clinical use recently. With these new fluids, various in vitro, ex vivo, and in vivo studies could demonstrate a better preservation of peritoneal cell viability and growth, less inhibited secretory cell functions, a significant reduction in the formation of advanced glycation end products (AGEs), and clinical signs for an improved preservation of peritoneal mesothelial cells indicated by an increase in effluent CA125. One has to be aware, however, that uremia per se prior to initiation of PD, as well as during PD treatment itself, directly impacts on peritoneal membrane structural changes so that new, more biocompatible PD fluids may not be completely sufficient to prevent morphologic and functional changes of the membrane. Due to a strong sodium sieving during APD, PD fluids with sodium concentrations of 125-130 mmol/L may be beneficial. Systematic calcium kinetic studies have not yet been performed in APD patients. APD fluids should offer a calcium concentration range of 1.0-1.75 mmol/L in order to enable an individualized APD prescription. For long-term APD treatment, better knowledge of peritoneal membrane physiology and PD kinetics should promote individualization of prescriptions. New, pH-neutral PD solutions with minimized amounts of GDPs may be a significant step forward to improved membrane preservation during long-term APD treatment.

Acidosis↗
PubMedDate not supplied

[Prenatal diagnosis and management of fetal arrhythmias].

Reported in this paper are 25 cases of fetal arrhythmia handled at the Gynaecological Department of the Berlin School of Medicine (Charité) over a period of two years. They were subdivided by tachycardiac, bradycardiac, and simple forms, following ultrasound-assisted diagnosis (realtime, M-Mode, Doppler). This proved to be useful for better prenatal management and prognosis. The first and second forms were linked to higher rates of malformations or contributory and recordable causes, whereas the third form could be considered harmless, the more as spontaneous postnatal regression was to be expected. Successful experience is reported, as obtained from prenatal therapy either via the mother or by direct invasive treatment to the child (thigh, umbilical vein). Early referral to an adequately staffed and equipped centre and exclusion of cardiac defects are conditions for good success. Intrauterine deaths occurred in two cases due to cardiac malformations, and non-immunological fetal hydrops was established in four cases. Optimal management of the inhomogenous group of fetal arrhythmias should be undertaken in interdisciplinary teamwork at centres with experience in perinatal medicine.

Adult↗
PubMedDate not supplied

[Residents of homes for the aged in Germany: characteristics of social structure and choice of nursing home].

In this paper some important aspects of institutionalization in old age are studied. Compared with old people living in private households, people living in residential care facilities show some sociostructural particularities which are hints at possible factors related to institutionalization. The following analyses of the factors related to institutionalization in old age result in a conformity of objective and subjective reasons: poor health, lack of social network and bad housing conditions in combination with needs for care are essential factors related to institutionalization. In addition, the question of denominational choice of the residential care facility and the question about migration in old age is examined more closely. With regard to the religious community it is amazing that, in spite of secularization, there are major interdenominational differences. A further analysis of regional mobility suggests some sociostructural differences: women and widowed persons for example do not move over far distances (from the private household to the residential care facility), compared to men and married persons.

Activities of Daily Living↗