Biomedical subjects

H Ulmer

Publications and source records attributed to H Ulmer.

At least 19 recordsLinked to original sources

PubMed2001

Risk factors associated with new onset tachyarrhythmias after cardiac surgery--a retrospective analysis.

BACKGROUND: Tachyarrhythmias (TA) represent a frequent and serious problem after cardiac surgery. We retrospectively analyzed 987 cardiac surgery patients admitted to a surgical intensive care unit between 1996 and 1999 to assess incidence and risk factors associated with development of postoperative TA in the intensive care unit. METHODS: TA (n=149) were defined as non-sinus rhythm with a heart rate (HR) > or =100 bpm in patients with preoperative sinus rhythm or as heart rate > or =130 bpm in patients with preoperative atrial fibrillation. A total of 787 patients served as controls (C). Demographic, premorbidity and perioperative data, admission SAPS and MODS-score, presence of clinical syndromes systemic inflammatory response syndrome (SIRS) and sepsis were univariately compared between groups. For prediction of independent risk factors for TA-development two multiple logistic regression models were finally established. RESULTS: Concerning TA, atrial fibrillation and flutter (76%) were observed most frequently, followed by paroxysmal supraventricular tachycardia (15%) and ventricular tachycardia/fibrillation (11%). Age, a history or presence of congestive heart failure, development of SIRS and sepsis, severity of multiple organ dysfunction syndrome and in particular severity of cardiovascular failure proved to be independent risk factors for development of TA. CONCLUSION: In cardiac surgery patients, age, a history or presence of congestive heart failure, postoperative development of a systemic inflammatory response syndrome or sepsis and the severity of multiple organ function syndrome were independent predictors for development of TA in the intensive care unit. The association of severity of cardiovascular dysfunction with TA strongly suggests a causal relationship between catecholamine therapy and TA-development.

Aged↗

PubMed2001

Effects of epinephrine on intestinal oxygen supply and mucosal tissue oxygen tension in pigs.

OBJECTIVE: To study the effects of increasing dosages of epinephrine given intravenously on intestinal oxygen supply and, in particular, mucosal tissue oxygen tension in an autoperfused, innervated jejunal segment. DESIGN: Prospective, randomized experimental study. SETTING: Animal research laboratory. SUBJECTS: Domestic pigs. INTERVENTIONS: Sixteen pigs were anesthetized, paralyzed, and normoventilated. A small segment of the jejunal mucosa was exposed by midline laparotomy and antimesenteric incision. Mucosal oxygen tension was measured by using Clark-type surface oxygen electrodes. Microvascular hemoglobin oxygen saturation and microvascular blood flow (perfusion units) were determined by tissue reflectance spectrophotometry and laser-Doppler velocimetry. Systemic hemodynamics, mesenteric-venous acid-base and blood gas variables, and systemic acid-base and blood gas variables were recorded. Measurements were performed after a resting period and at 20-min intervals during infusion of increasing dosages of epinephrine (n = 8; 0.01, 0.05, 0.1, 0.5, 1, and 2 microg x kg(-1) x min(-1)) or without treatment (n = 8). In addition, arterial and mesenteric-venous lactate concentrations were measured at baseline and at 60 and 120 mins. MEASUREMENTS AND MAIN RESULTS: Epinephrine infusion led to significant tachycardia; an increase in cardiac output, systemic oxygen delivery, and oxygen consumption; and development of lactic acidosis. Epinephrine significantly increased jejunal microvascular blood flow (baseline, 267 +/- 39 perfusion units; maximum value, 443 +/- 35 perfusion units) and mucosal oxygen tension (baseline, 36 +/- 2.0 torr [4.79 +/- 0.27 kPa]; maximum value, 48 +/- 2.8 torr [6.39 +/- 0.37 kPa]) and increased hemoglobin oxygen saturation above baseline. Epinephrine increased mesenteric venous lactate concentration (baseline, 2.9 +/- 0.6 mmol x L(-1); maximum value, 5.5 +/- 0.2 mmol x L(-1)) without development of an arterial-mesenteric venous lactate concentration gradient. CONCLUSIONS: Epinephrine increased jejunal microvascular blood flow and mucosal tissue oxygen supply at moderate to high dosages. Lactic acidosis that develops during infusion of increasing dosages of epinephrine is not related to development of gastrointestinal hypoxia.

Acidosis, Lactic↗

PubMed2001

The incidence of combined facial and cervical spine injuries.

BACKGROUND: The association between facial and cervical spine injuries has been documented. However, only severe spinal injuries were included in previous analyses. It was the purpose of this study to evaluate the incidence of and risk factors for these injury combinations including the complete injury spectrum. METHODS: Between 1995 and 1997, 4,907 patients with cervical spine injuries were treated at our hospital. One hundred five (2.14%) of these patients had suffered a concomitant facial injury. This group was compared with the group of patients with cervical spine injury but without facial trauma. RESULTS: The majority of cases (98%) consisted of minor lesions to both regions. With increasing severity of cervical spine trauma, the risk for facial injury increased. Age and male gender represent significant (p < 0.05) risk factors for combined injuries. CONCLUSION: Patients sustaining cervical spine trauma have a small but real chance of injuring their face as well. The cervical spine must be examined carefully, whenever facial injuries are present.

Adolescent↗

PubMed2001

Studies of in vitro activities of voriconazole and itraconazole against Aspergillus hyphae using viability staining.

The minimal fungicidal concentrations (MFCs) of voriconazole and itraconazole for five clinical isolates each of Aspergillus terreus, Aspergillus fumigatus, Aspergillus flavus, and Aspergillus niger were determined by a broth macrodilution method. Conidial suspensions as inocula were compared to hyphae as inocula since the invasive form of aspergillosis is manifested by the appearance of hyphal structures. In addition, cell viability staining with the dye FUN-1 was performed to assess time-dependent damage of hyphae exposed to various concentrations of the antifungal agents. With conidial inocula the MFC ranges of voriconazole were 0.5 to 4 microg/ml and those of itraconazole were 0.25 to 2 microg/ml, whereas the MFCs (2 to >16 microg/ml) with hyphal inocula were substantially higher (P < 0.01) for both itraconazole and voriconazole. Only minor differences between the tested antifungals were observed since 16 of 20 and 17 of 20 of the isolates of Aspergillus spp. tested appeared to be killed by voriconazole and itraconazole, respectively. The results of FUN-1 viability staining correlated closely to colony counts, but various time- and dose-dependent levels of viability of hyphae were also observed. In conclusion, our study demonstrates the importance of the type of inoculum used to test antifungals and the applicability of FUN-1 staining as a rapid and sensitive method for assaying the viability of hyphae.

Antifungal Agents↗

PubMed2000

Low-power laser light in the healing of burns: a comparison between two different wavelengths (635 nm and 690 nm) and a placebo group.

BACKGROUND AND OBJECTIVE: Studies on the influence of low-power laser light on wound healing have shown inconsistent results, or, as in the case of burns, are very scarce. We have studied the effects of two different low-power diode laser lights on the healing of burns in rats. STUDY DESIGN/MATERIALS AND METHODS: Thirty rats were burned on both flanks and randomly allocated to one of three study groups. In group A, both wounds remained untreated; in groups B and C, one wound each was irradiated with 635 nm or 690 nm laser light (1.5 J/cm(2)), whereas the other wound remained untreated. Diameter, redness, and edema of the wounds were examined daily. RESULTS: Between and within groups, diameter, redness, and edema of the wounds were similar throughout the entire observation period. Irradiation of the burns did not accelerate wound healing when compared with control wounds. CONCLUSION: We conclude that neither 690 nm nor 635 nm low-power laser light produced any beneficial effects on the healing processes of burns in rats.

Analysis of Variance↗

PubMed2000

[Surgical stabilization of per- and subtrochanteric femoral fractures with the gamma nail].

BACKGROUND: From 1992 through 1997 96 patients with per- or subtrochanteric femur fractures were treated with a Gamma nail. We retrospectively evaluated the influence of patient age, additional diseases, type of fracture, time of operation, type of implant (short/long Gamma nail) and surgical approach (open/closed reduction) on the mobility of the patients, healing of the fractures on radiographs, and possible complications. PATIENTS AND METHODS: The average patient age was 72.5 years (range 27 to 101). There were 27 male and 69 female patients. Surgery was performed 1.19 (0-10) days after injury. At 3, 6, and 12 months after surgery radiographs of the involved hip joint and femur were obtained and the degree of mobility was assessed. RESULTS: Additional diseases, type of fracture, time of operation, type of implant (short/long Gamma nail) and surgical approach (open/closed reduction) did not influence mobility of the patients, healing of the fractures on radiographs or rate of complications. It was more difficult to mobilize older patients (P < 0.001). After 1 year 97% of all fractures had healed on radiographs. In 15 patients (18%) complications occurred due to technical errors using the Gamma nail. DISCUSSION: With the Gamma nail stable osteosynthesis of per- and subtrochanteric femur fractures is obtained independently of the fracture classification. Patients can be mobilized immediately. Technical errors must be avoided.

Adult↗

PubMed2000

Tachyarrhythmias in a surgical intensive care unit: a case-controlled epidemiologic study.

OBJECTIVE: Incidence, types, and factors associated with new onset tachyarrhythmias (TA) in surgical intensive care patients. DESIGN: Pairwise-matched case-controlled study. SETTING: Surgical intensive care unit (ICU) with nine intensive care beds. PATIENTS: During a 1-year period, all TA patients (n = 89) were included in the study. Control patients (n = 82) without TA were matched according to age, sex, and surgical region. METHODS: TA workup included: 12-lead ECG, arterial blood gas, serum electrolyte (K+, Mg2+), and serum CK/CKMB isoenzyme analysis. Pre-existing cardiovascular and pulmonary disease, cardiovascular risk factors, preoperative regular medication, and admission SAPS were recorded in all patients. A multiple organ dysfunction syndrome (MODS) score, the presence or absence of SIRS or sepsis, and hemodynamics (MAP and CVP) before onset of TA were evaluated in TA patients, while in control patients highest MODS-score, the presence or absence of SIRS or sepsis, mean hemodynamic and laboratory values calculated from highest and lowest readings during ICU stay were used for statistical comparison. Logistic regression analysis was performed to identify variables multivariately associated with TA. RESULTS: Eighty-nine (14.8%) of 596 patients developed TA. Atrial fibrillation was most frequent (60.7%). Presence of SIRS or sepsis (adj. OR = 36.45; 95% CI: 11.5-115.5), high admission SAPS (adj. OR = 1.25/point; 95% CI: 1.08-1.44), high CVP (adj. OR = 1.27/mmHg; 95% CI: 1.09-1.48), and low arterial oxygen tension (adj. OR = 0.97/mmHg); 95% CI: 0.95-0.99) were found to be significant predictors for development of TA. CONCLUSIONS: In surgical patients hypoxia, high cardiac filling pressures, a greater degree of physiologic derangement at admission, and the presence of SIRS and sepsis are independent risk factors for the development of TA.

Aged↗

PubMed2000

Bilateral investigation of the temporomandibular joint. An autopsy study of edentulous individuals.

Investigations concerning normal and pathological anatomy of the temporomandibular joint (TMJ) have shown that pathological reactions such as deviations of the shape of the condyle, disc thinnings, disc perforations and osteoarthrotic changes are fairly common, particularly in the elderly population. Autopsy studies of the TMJ describe pathological findings respective to their location in different age groups, but most authors describe their findings for removed joints of one side only. The specific aim of this study was therefore to investigate the intra-individual relationships between the degenerative changes and deviations concerning the articular surfaces of the TMJs and the topographical distributions of these findings. In this investigation both joints of 22 edentulous individuals between 58 and 95 years of age were studied. Correlations were found between the right and left joints with respect to the anatomical location of the pathological findings.

Aged↗

PubMed2000

Prior myocardial infarction is the major risk factor associated with sudden cardiac death during downhill skiing.

More than 90% of all sudden cardiac deaths (SCDs) during downhill skiing, the most popular winter sport world-wide, are attributed to men over the age of 34. However, no data exist on additional risk factors and triggers for SCD related to downhill skiing. Therefore risk factor profiles of 68 males who died from SCD during downhill skiing were compared to those of 204 matched controls. Skiers who suffered SCD had much more frequently prior myocardial infarction (MI) (41% vs. 1.5%; p<0.001), hypertension (50% vs. 17%; p<0.001), known coronary heart disease (CHD) without prior MI (9% vs. 3%; p=0.05) and were less engaged in strenuous exercise (4% vs. 15%; p<0.05) when compared to controls. Multivariate analyses even enhanced the importance of these risk factors. Downhill skiing is considered to be a serious trigger for SCD especially in skiers with prior MI but also for those with hypertension, known CHD without prior MI, or insufficient adaptation to strenuous exercise. Skiing-related increased sympathetic activity might well disturb the autonomic balance with subsequent arrhythmias and/or may increase cardiac work and platelet aggregability with possible plaque rupture and coronary thrombosis. Therefore adaptation to high intensity exercise and therapeutic interventions or abstinence from skiing in certain cases should be considered for downhill skiers at high risk.

Aged↗

PubMed2000

High-frequency oscillatory ventilation does not decrease endothelin release in lung-lavaged rabbits.

UNLABELLED: High-frequency oscillatory ventilation (HFO) has been shown to reduce lung injury and pulmonary arterial pressure (PAP). We hypothesized that HFO leads to decreased endothelin 1 (ET-1) and endothelin 3 (ET-3) release when compared to conventional mechanical ventilation (CMV) in lung-lavaged rabbits. DESIGN: Prospective, randomized, controlled animal study. In 26 adult New Zealand White Rabbits ventilated by CMV or HFO under hypoxemic and normoxemic conditions after lung lavage (CMV-hypo: n = 5; CMV-normo: n = 8; HFO-hypo: n = 7; HFO-normo: n = 6) we recorded systemic and PAP, measured blood gases, ET-1 and ET-3 and calculated intrapulmonary venous admixture during a 4-h experiment. ET-1 was significantly increased after lavage (p < 0.05) with no further increase until the end of the experiment. Neither pulmonary arterial nor systemic arterial ET-1 differed between CMV and HFO or between hypoxemia and normoxemia. Systemic arterial ET-3, however, was significantly higher in HFO-hypo than in the other two groups ventilated under normoxemic conditions at the end of the experiment (HFO-hypo vs. CMV-normo, p < 0.05; HFO-hypo vs. HFO-normo, p < 0.05). PAP showed a continuous increase in all groups (p < 0.05). We did not find any correlation between PAP and ET-1 or ET-3. Intrapulmonary venous admixture increased in animals ventilated under hypoxemic conditions, whereas it decreased after lung lavage in those ventilated under normoxemic conditions until the end of the experiment (HFO-normo, p < 0.05). CONCLUSIONS: This study suggests that HFO does not decrease ET-1 and ET-3 release compared to CMV in lung-lavaged rabbits. Hypoxemia, however, may increase ET-3 release from the lungs, leading to an increased intrapulmonary shunt.

Animals↗

PubMed2000

Off-label use of antipsychotic drugs.

Despite the fact that most antipsychotics have only been formally evaluated for the treatment of schizophreniform disorder, schizophrenia, mania, and schizoaffective disorder (defined as "classical indications"), antipsychotics are widely used for the treatment of a broad range of symptoms and disorders. In this study, 173 patients who were having their prescriptions for antipsychotics filled at local pharmacies were interviewed. In 115 patients (66.5%), an antipsychotic was prescribed for off-label indications. Patients most often stated that they took antipsychotics as a tranquilizer or an anxiolytic. Neither gender, education, duration of treatment, nor efficacy of treatment showed an influence on the prescription practices for antipsychotics. In contrast, family status and side effects showed a significant influence. A classical indication was more often found in married and widowed patients than in unmarried or divorced ones. Patients in whom antipsychotics were prescribed for the treatment of schizophrenia, schizophreniform disorder, mania, or schizoaffective disorder experienced side effects more often than others. Age was also important for the indication of antipsychotics. Classical indications of antipsychotics were most often found in patients aged 30 to 49 years. In older patients (49-70 years), antipsychotics were almost exclusively used for off-label indications. In classical indications, clozapine was used more frequently (50%) than other antipsychotics. Melperone was primarily prescribed for off-label use.

Adolescent↗

PubMed2000

Tolerance of N-chlorotaurine, a new antimicrobial agent, in infectious conjunctivitis - a phase II pilot study.

N-Chlorotaurine (NCT) is an endogenous microbicidal oxidant. This open pilot study (phase IIa) with 9 patients was done to gain first knowledge on the tolerance of NCT in infectious conjunctivitis. By application of 1% NCT 5 times a day, no adverse effects could be observed. All 6 subjects with bacterial conjunctivitis were cured within 3-5 days. Two subjects with epidemic keratoconjunctivitis were treated for 7-10 days and 1 subject with herpes simplex blepharitis for 3 days with no rapid improvement but probable mitigation of inflammation. Therefore, NCT seems to be useful in the treatment of infectious conjunctivitis, and further investigation on its therapeutic efficacy is suggested.

Adolescent↗

PubMed2000

Performance of GC-MS and MOSES II, a hybrid modular sensor system, for the quantitative detection of the evaporation of the insect repellent N,N-diethyl-m-toluamide from two different matrices.

The purpose of this work was to determine the evaporated amount of N,N-diethyl-m-toluamide (DEET), a commonly used insect repellent, from two different matrices medium chain triglycerides (MCT) and Polyethylene glycol 400 (PEG), with GC with mass sensitive detection (GC-MS) and a hybrid modular sensor system (MOSES II). Thus, the binary mixtures are equilibrated at 80 degrees C for 45 min and then an aliquot of this headspace is analyzed by GC-MS and a sensory system consisting of an array of eight metal oxide sensors and eight quartz crystal microbalances. Both analytical methods allow a sensitive detection of even small amounts of DEET in the headspace from binary mixtures with the MCT or PEG, respectively. The two additives are found to be very different concerning their behavior to the vapor phase; i.e., the lipophilic (MCT) delivers an almost constant headspace of DEET, while the hydrophilic matrix PEG releases smaller amounts of DEET, which continuously decrease when a multiple headspace extraction is performed. Furthermore, the results reveal that both analytical methods lead to comparable results with the MCT/DEET mixtures whereas differences were seen with mixtures containing PEG. This can be attributed to the interaction of volatile portions of PEG with the sensors of the MOSES II.

Autoanalysis↗

PubMed1999

Early postnatal depressive mood: associations with obstetric and psychosocial factors.

The central purpose of this investigation was to detect incidence and influencing factors on early postnatal depressive mood in a large hospital sample. By means of an interview we acquired information on sociodemographic data, physical and psychiatric anamnesis, and obstetric and psychologic variables. The Edinburgh Postnatal Depression Scale (EPDS) served to determine the depressive mood of our patients. The interview was carried out on 1250 women at two postnatal wards 5 days after delivery. According to the results of the German validation of the EPDS, where a cutoff of 9/10 indicates at least mild depressive disorder, the whole sample was divided into group A (EPDS score < or = 9; n = 996, 79.7%) and group B (EPDS score > or = 10; n = 254, 20.3%). Early postnatal depressive mood, as assessed by the EPDS, appeared with 20% of all women taking part in our investigation on the fifth postnatal day. Subjective measurements such as high childbirth burden, elevated trait anxiety, low life satisfaction and lower social class, and low birth weight of the infant seem to be of predominant relevance for early postnatal depressive mood.

Adult↗

PubMed1999

Incidence of oral and maxillofacial skiing injuries due to different injury mechanisms.

PURPOSE: This study emphasizes the significance of maxillofacial injuries in skiing accidents, correlating injury mechanisms and patterns, by evaluating a large population of maxillofacial injuries over a 6-year period. PATIENTS AND METHODS: Between 1991 and 1996, of 5,623 patients showing oral and maxillofacial injuries, 1,859 were sports-related. Records of 579 patients with 882 incidents of oral and maxillofacial injury due to skiing were reviewed and analyzed according to age, sex, type of injury, cause of accident, location, and frequency of fractures. Additionally, the five main injury mechanisms were analyzed. RESULTS: The oral and maxillofacial injuries in 10.3% of all trauma patients, or 33% of all sports-related trauma patients, were due to skiing. A total of 310 patients (53.5%) had facial bone fractures, 236 patients (40.8%) suffered from dentoalveolar trauma, and 336 patients (58%) showed soft tissue injuries. Five major causes and mechanisms of injury existed, namely, 263 falls (45%); 135 collisions with other skiers (23%); 70 individuals struck by their own ski equipment (12%); 46 collisions against stationary objects (8%); and 34 lift-track accidents (6%). Sex distribution showed an overall male-to-female ratio of 1.9:1.0, but varied depending on the injury mechanism. The age distribution ranged from 2 to 81 years. CONCLUSION: The results of this study show the high incidence of oral and maxillofacial injuries due to skiing accidents. Depending on the mechanism of injury, different patterns occur. Facial bone fractures are more likely in collisions with other persons, falls, and collisions with stationary objects, whereas dentoalveolar trauma is more common when persons are struck by their own ski equipment, or when accidents on lift-tracks occur.

Accidental Falls↗

PubMed1999

Spatial analysis of Percutaneous Transluminal Coronary Angioplasty (PTCA) in Austria.

STUDY OBJECTIVES: To investigate the geographical distribution of Percutaneous Transluminal Coronary Angioplasty (PTCA) and morbidity for coronary heart disease, angina pectoris and myocardial infarction by spatial analysis of the standardized morbidity rates (SMR) on district level. To identify clusters by Moran's I Statistic and the Regional Spatial Autocorrelation Coefficient (RSAC) of Munasinghe and Morris. To investigate demand factor morbidity and supply factor health care infrastructure on the district level as reasons for geographical disparity. To describe characteristics of the cluster population and intervention centres. STUDY DESIGN: Retrospective record linkage study. SETTING: All hospitals and cardiological centres in Austria (n = 150) which performed the Minimum Basic Data Set (MBDS). PATIENTS: All Austrian residents who were diagnosed for myocardial infarction, coronary heart disease or angina pectoris in 1995 (n = 87,174). MEASUREMENTS AND MAIN RESULTS: One 'positive' PTCA cluster (all SMRs > or =0.96) and one 'negative' PTCA cluster (all SMRs < or =0.59) were identified. They differed significantly in morbidity rate, intervention rate and available cardiological beds. The tendency to inverse relation between PTCA utilization and morbidity in the 'negative' cluster supported the thesis of 'inverse care law'. Austrianwide no significant correlation was found between the SMR of PTCA-application and both demand factor and supply factors. Nevertheless, differences between the clusters concerning number and capacity of intervention centres and density of specialists pointed to supply factors as reasons for geographical disparity. The ongoing trend of steady expansion of existing intervention centres and establishment of new ones will reduce the extent of geographical variation in future.

Angioplasty, Balloon, Coronary↗

PubMed1999

Pulmonary Aspergillus colonization in humans and its impact on management of critically ill patients.

Samples of lung tissues were obtained and analysed for Aspergillus carriage in 56 patients undergoing thoracic surgical intervention and 18 people who had an unexpected death. Out of 74 samples, 46 (63%) had evidence of pulmonary fungal colonization. The surgery population had a rate of 62% of fungal growth. Aspergillus was present in 39%. The autopsy population had a rate of 61% of fungal colonization. Aspergillus was present in 41%. In these cases eradication of fungal spores residing in the lung prior to aggressive chemotherapy and prevention of further spore uptake during hospitalization is indispensable in preventing pulmonary aspergillosis.

Aspergillosis↗

PubMed1999

Quantitative analysis of masseter and temporalis EMGs: a comparison of anterior guided versus balanced occlusal concepts in patients wearing complete dentures.

The lack of easily measurable, objective physiological activity parameters of the masseter and temporalis muscle during jaw movements in humans has led to the consideration to revise data of surface electromyographies (EMGs) by applying a computerized quantification method. The aim of this follow-up analysis was to get quantitative data out of EMG-records of an earlier study. These records were obtained with two different splints, splint 1 providing an anterior front-canine guidance and splint 2 providing bilateral balanced occlusion. Utilizing a computer aided integration method led to numeric results which statistically proves the prediction of the previous investigation. Applying the integration method, the EMG raw signal was transformed into area-values which enabled a statistical work up of the data. Wilcoxon test statistics shows a significant (P<0.05) lower muscle activity in patients wearing dentures providing anterior front-canine guidance compared to those with balanced occlusion. It is concluded that the neuromuscular activity of the elevator muscles is highly reproducible and that the neuromuscular function is similar in edentulous subjects to that found in people with natural teeth. Furthermore, the study statistically proves earlier visual data that all those subjects, whose muscle activities were observed with anterior guidance (splint 1) compared to bilateral balanced occlusion (splint 2) showed significantly lower values with regard to subjects wearing splint 2.

Centric Relation↗