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Biomedical subjects

H Ulmer

Publications and source records attributed to H Ulmer.

At least 91 records · Page 5Linked to original sources
PubMed1997

Spontaneous abortion and psychosomatics. A prospective study on the impact of psychological factors as a cause for recurrent spontaneous abortion.

A group of 36 patients who had had at least two consecutive spontaneous abortions and who desired to have children was subjected to a psychosomatic investigation before a biomedical diagnostic screening programme was started. A semi-structured interview regarding sociodemographic data, current relationship, social support, education, occupation and medical anamnesis was carried out. In addition, all women completed four standardized questionnaires on the topics of anxiety, somatization disorder, life satisfaction and depression. A control group of 36 women, matched for age and occupation, was subjected to the same psychosomatic investigation. The findings of the diagnostic screening programme showed that 16 women had abortions because of physical abnormality, and 15 women had no physically confirmed cause (in five women, the investigations were not completed). Following recurrent spontaneous abortion, 18 women had a successful pregnancy within 2 years, and 18 women were still childless. The comparison between patients and the control group revealed that patients with recurrent abortion were significantly more satisfied with their life quality regarding leisure time, financial situation and occupation. No significant differences were observed in any other variables. Patients who suffered spontaneous abortions due to a physical disorder showed partner relationship of longer duration, and more frequent miscarriages. Women with successful pregnancy within 2 years after recurrent miscarriage were significantly younger and had fewer physically related abortions compared with women who remained childless. In summary, psychological factors seem to be of subordinate importance as a cause for recurrent spontaneous abortion. Moreover, physical abnormalities in the reproductive system have a predominant impact on the prediction of a future successful pregnancy.

Abortion, Habitual↗
PubMed1997

Inotropic treatment and intestinal mucosal tissue oxygenation in a model of porcine endotoxemia.

OBJECTIVE: To evaluate the dose-related effects of dopamine, dopexamine, and dobutamine on intestinal mucosal tissue oxygenation following short-time infusion of Escherichia coli lipopolysaccharide, which has previously been shown to decrease mucosal tissue oxygenation by 60% of control values. DESIGN: Prospective, randomized, unblinded study. SETTING: Animal research laboratory. SUBJECTS: Anesthetized, mechanically ventilated domestic pigs. INTERVENTIONS: Pigs were infused with 2 microg/kg of E. coli lipopolysaccharide over 20 mins via the superior mesenteric artery. Pulmonary artery occlusion pressure was maintained near 15 mm Hg, using a mixed infusion regimen of Ringer's lactate solution and hydroxyethyl starch. Following endotoxemia, a small segment of the jejunal mucosa was exposed by midline laparotomy and antimesenteric incision. The control group (n = 7) received no further interventions. Pigs in the dopamine (n = 7), dopexamine (n = 7), and dobutamine (n = 7) groups were infused with 2.5, 5, 10, and 20 microg/kg/min of the respective drug via a central venous catheter. MEASUREMENTS AND MAIN RESULTS: Systemic hemodynamics as well as systemic, mesenteric, and femoral blood gas variables were measured using an arterial, a thermodilution pulmonary artery, a superior mesenteric venous, and a femoral venous catheter. Jejunal mucosal tissue PO2 was measured by means of two Clark-type surface oxygen electrodes. Oxygen saturation of jejunal mucosal microvascular hemoglobin was determined by tissue reflectance spectrophotometry. Infusion of endotoxin resulted in pulmonary hypertension. Systemic hemodynamics remained unchanged except for brief decreases in cardiac output and arterial blood pressure. Dopamine, dopexamine, and dobutamine increased systemic oxygen delivery in a dose-related manner by 80% (p < .01), 96% (p = .00), and 129% (p = .00) of values before inotropic treatment. Dopamine increased mucosal tissue PO2 by 109% (10-microg dose, p < .01) and 164% (20-microg dose, p = .00), and mucosal hemoglobin oxygen saturation by 61% (5-microg dose, p < .05), 102% (10-microg dose, p < 01) and 121% (20-microg dose, p = .00). Dopexamine increased mucosal tissue PO2 by 89% (20-microg dose, p < .01) and mucosal hemoglobin oxygen saturation by 26% (2.5-microg dose, p < .05) and 35% (5-, 10-, and 20-microg dose, p < .05). In the dobutamine and control groups, no significant effect on either mucosal tissue PO2 or hemoglobin oxygen saturation was observed. CONCLUSIONS: In this model of porcine endotoxemia, dopamine and, to a lesser extent, dopexamine increase intestinal mucosal tissue oxygenation. Of all three inotropes used, dobutamine has the most pronounced effect on systemic oxygen delivery, but it does not improve mucosal tissue oxygenation. Selective vasodilation within the intestinal mucosa, mediated mainly by dopamine-1 receptors, seems to explain the observed intestinal mucosal effect of dopamine and dopexamine.

Animals↗
PubMed1997

Prenatal findings in patients with prolonged QT interval in the neonatal period.

OBJECTIVE: To describe prenatal abnormalities of cardiac rhythm in patients with prolonged QT interval in the neonatal period. DESIGN: A retrospective analysis of the results of fetal echocardiography and the outcome in patients with prolonged QT interval in the neonatal period who had been referred for prenatal evaluation. SETTING: Two university hospitals. PATIENTS: Nine patients with prolonged QT interval in the neonatal period who had been referred for prenatal evaluation. Fetal echocardiograms were obtained from 24 to 40 weeks of gestation. Indications were fetal bradycardia (five patients), a family history of long QT syndrome (two patients), and complex arrhythmias (two patients). RESULTS: Seven fetuses had persistent sinus bradycardia without ventricular arrhythmias (heart rates 70-120 beats/ min). Five patients were treated with propranolol, after the diagnosis had been established by postnatal electrocardiogram (ECG). One of these patients died suddenly at the age of 3 weeks, after the treatment had been stopped because of profound bradycardia. One of the remaining two patients who did not receive propranolol had a syncope at the age of 6 weeks. Two fetuses presented with frequent runs of ventricular tachycardia and intermittent bradycardia caused by intermittent, functional second degree atrioventricular block. Both patients died on the first day of life despite treatment with propranolol and transvenous temporary pacing. CONCLUSIONS: Sinus bradycardia in an otherwise normal fetus may be a symptom of long QT syndrome. Postnatal ECGs and a family examination are strongly recommended in these children. In fetuses with frequent runs of ventricular tachycardia and intermittent second degree atrioventricular block long QT syndrome should be suspected prenatally. These high risk patients should be delivered in centres with a paediatric cardiology unit.

Anti-Arrhythmia Agents↗
PubMed1997

Muscular involvement in the Holt-Oram syndrome.

Holt-Oram syndrome is an autosomal dominant disorder characterised by radial ray and congenital heart defects. Recently, a gene for this disorder has been identified on chromosome 12q24.1, encoding a T box transcription factor. However, the functional role of the gene product is not completely understood. We present results of neurological, radiological, and muscle magnetic resonance imaging (MRI) investigations in 13 patients from eight unrelated families. Besides heart defects, clinical signs ranged from thenar abnormalities to bilateral phocomelia. The former were present in all patients. MRI showed hypoplasia of discrete muscles which clinically showed as non-progressive weakness. The structural pattern of residual muscles was normal on MRI, which together with normal muscular power, electromyography, and muscle enzyme investigations excluded a progressive neuromuscular disorder. The number and location of hypoplastic muscles correlated with the severity of skeletal involvement. Thus, patients with hypoplasia of large and proximal muscles had phocomelia, and those with mere intrinsic hand muscle hypoplasia had only a triphalangeal thumb or no skeletal malformation. On the basis of these observations, we conclude that disturbed fetal limb muscle development is involved in the bony malformations of the upper limbs.

Adult↗
PubMed1996

[Comparison and outcome of grade II and III acromioclavicular joint injuries].

Eighty-five patients with grade 2 or grade 3 sprains of the acromioclavicular (AC) joint were evaluated clinically and radiographically 32 months after injury. Group I included 34 patients with grade 2 sprains (Tossy II) and group II included 51 patients with grade 3 injuries (Tossy III). In group I, 15 patients were treated surgically (group Ia) and 19 patients were treated conservatively (group Ib), while in group II, 41 patients were treated surgically (group IIa) and 10 patients were treated conservatively (group IIb). At surgery open reduction and transarticular fixation of the AC joint with Kirschner wires was performed. Conservative treatment included the initial use of a sling or a knapsack bandage and early performance of range-of-motion exercises. Shoulder function was assessed according to the score devised by Constant and Murley. In both groups, 97 of 100 possible points (minimum 72, maximum 100) were obtained after conservative and after surgical treatment. Nine of 10 patients (90%) with grade 3 sprains (group IIb) had more pronounced displacement and increased mobility of the lateral end of the clavicle after conservative treatment. After surgery, dislocation and increased horizontal, mobility of the lateral end of the clavicle occurred in 18 (44%) of 41 patients with grade 3 sprains (group IIa P < 0.0001). However, these findings did not correlate with the functional outcome. At follow-up there was a significant increase in degenerative changes seen on radiographs (P < 0.035) in all patients. Again these findings did not correlate with the functional outcome. More degenerative radiological changes were observed in patients who had undergone surgery (P < 0.003). Patients with grade 2 sprains were more frequently restricted in sporting activity after surgery (P < 0.05). Patients with grade 3 sprains who were treated surgically complained of pain more frequently (P < 0.01), and they returned to work later than patients who were treated conservatively after grade 3 sprains. An additional rehabilitation program guided by a physiotherapist seemed to have no impact on the functional outcome. A total of 56 patients were treated by surgery. Among these patients 11 complications occurred, requiring five additional surgical procedures. Among 29 conservatively treated patients, only in 1 patient did subacromially located arthritic changes of the AC joint have to be removed.

Acromioclavicular Joint↗
PubMed1996

Influence of induction technique on intubating conditions after rocuronium in adults: comparison with rapid-sequence induction using thiopentone and suxamethonium.

We have assessed the effect of anaesthetic technique on intubating conditions after rocuronium 0.6 mg kg-1 in four groups (n = 25 each) of unpremedicated patients in whom anaesthesia was induced with either thiopentone 5 mg kg-1 or propofol 2.5 mg kg-1 alone, or supplemented with alfentanil 20 micrograms kg-1. Fifty control patients were anaesthetized with thiopentone followed by suxamethonium. Laryngoscopy was commenced at 45 s. Overall intubating conditions after rocuronium were similar to those after suxamethonium (good and excellent > or = 96%) only when alfentanil was part of the induction regimen. However, intubation time was similar in all five groups and averaged 55 (SD 3.2) s, and the tube could be passed through open vocal cords within 70 s. After rocuronium the response of the diaphragm to intubation was more pronounced in the two groups of patients not receiving alfentanil (P < 0.0001) and in patients anaesthetized using propofol with alfentanil (P < 0.01) than in the control group. Opioids (in doses equivalent to alfentanil 20 micrograms kg-1) constitute an integral part of an induction regimen containing rocuronium 0.6 mg kg-1, regardless of whether or not thiopentone or propofol is used, in order to achieve overall intubating conditions similar to those after suxamethonium.

Adolescent↗
PubMed1996

Grid pattern photocoagulation for diabetic macular edema--long-term visual results.

The authors reviewed the data of 226 eyes in 124 patients with clinically significant diabetic macular edema treated by grid pattern photocoagulation from 1986 to 1994 at the Ophthalmological Clinic of Innsbruck University Hospital. On the basis of baseline visual acuity (VA), eyes were classified in four groups: group 1 = VA < 0.1; group 2 = VA 0.1-0.2; group 3 = VA > 0.2-0.5; group 4 = VA > 0.5. The development of VA from the baseline examination until the last checkup in treated eyes is reported. This classification showed a better visual outcome after photocoagulation in eyes with a decreased VA at baseline (groups 1, 2) compared with eyes with a good initial VA (groups 3, 4). The difference in visual outcome between the second and third groups as well as between the third and fourth groups was statistically significant (p < or = 0.001). A correlation of initial VA with visual outcome after treatment was demonstrated (R = -0.558; p = 0.0001). Clinical conclusions of these results are discussed.

Adult↗
PubMed1995

Therapy of glioblastoma multiforme: a cumulative experience of 10 years.

PURPOSE: Comparison of the effect of different therapeutic modalities on survival time of patients with glioblastoma multiforme operated on during the last decade (1980-1990). PATIENTS AND METHODS: The records of 157 consecutive patients with the histological diagnosis of glioblastoma multiforme were analysed for survival with respect to age of patients, extent of surgery, influence of re-operation and adjuvant postoperative treatment. The latter included fractionated radiotherapy, chemotherapy (BCNU. CCNU with Vincristine) and photodynamic therapy (PDT). RESULTS: Analysis of variance showed a significant effect for survival after macroscopically radical surgery (p = 0.005), postoperative radiotherapy (p < 0.001), chemotherapy (p < 0.01). Low age (p < 0.05) and a postoperative Karnofsky performance score (KPS) > or = 60 (p < 0.001) had a positive influence: the site of tumour and pre-operative presence of seizures had no significant influence (p > 0.1) on survival time. CONCLUSION: We conclude that the current adequate management of glioblastoma multiforme should include surgical resection followed by adjuvant treatment such as radiotherapy and chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

[The oral health status of emergency dental patients in Austria].

It is often suggested that people who require emergency dental treatment are mainly those who do not care about their teeth and do not have regular visits to their dentist. Little is known about their dental health. Therefore a study was initiated to get more information on the oral health state of these people. The dental care for these patients could be improved selectively in future. 1214 patients using the emergency dental service at the University Clinic for Dentistry in Innsbruck/Austria where examined. More than 40% of these patients had untreated dental caries. Remnants of teeth, as the result of carious destruction, were found in 13.3% of these people. The (dt+DT) value was 2.4 at the age 3-12 years. 6.5 teeth on average were missing at the age 35-44 and about 40% of these patients did not wear a dental appliance for replacement of missing teeth. The emergency dental service was used most frequently by people aged 25 to 35 years. It can be assumed that especially this age-group does not care enough about their teeth. Therefore an effective dental health service including these people as well as some certain profession-groups which were found in this study to stand out by reduced oral health could improve the oral health by economically justifiable costs.

Adolescent↗
PubMed1994

Fallot complex, severe mental, and growth retardation: a new autosomal recessive syndrome?

We report on the syndromic occurrence of the Fallot complex in sibs born to consanguineous Pakistani parents. Additional manifestations included minor facial anomalies, pronounced failure to thrive, and mental retardation. Expression of the syndrome varied. While one of the four patients had cardiac malformations, another sib had only non-cardiac manifestations. The clinical findings suggest a new autosomal recessive syndrome.

Abnormalities, Multiple↗
PubMed1994

[The functional evaluation of orthodontically aligned impacted canines].

The purpose of this study was to examine functional occlusion of impacted maxillary canines which had been moved orthodontically into the line of occlusion. Examinations were performed on both patients and on an articulator, which was adapted to correspond to the axiographical findings. Functional contacts on the working side during lateral movement of the mandible were found in all orthodontically aligned impacted canines. Half the aligned teeth were involved in canine guidance, half in group function. Balancing side interferences were detected in 22% of the cases. The result of this study revealed a nearly identical function in the aligned canines when compared with the spontaneously erupted canines on the other side of the same maxilla. This became apparent during lateral excursion of the mandible. The angle of mesiodistal inclination of the tooth central axis with an occlusal plane was 84 degrees for aligned and 82 degrees on average for the spontaneously erupted canines.

Adolescent↗
PubMed1992

Atrial automatic tachycardia in infancy and childhood.

Twenty-one cases (13 male, eight female) of atrial automatic tachycardia (AAT) assessed by standard and Holter-ECG in otherwise healthy infants and children have been documented. AAT was incessant in 12 patients, repetitive in seven, and of undetermined type in the remaining two. The frontal P wave axis suggested an ectopic focus in the high right atrium or right atrial appendage in 13 patients, in the low right atrium in one patient, and in the left atrium in seven patients. Thirteen out of 14 patients with the incessant or undetermined type of AAT were symptomatic, in contrast to only two of seven patients with the repetitive type. All patients were treated with between one and eight (median three) antiarrhythmic drugs. The most effective drug was amiodarone, followed by the class I C antiarrhythmic drugs, propafenone and flecainide. At present, all patients are alive 4 months to 21 years (median 2.5 years) after diagnosis of AAT. Twelve patients are in sinus rhythm, five of them without any medication. Nine patients still have AAT, which, however, is repetitive or intermittent in all but one. In conclusion, AAT is an unusual, and in its incessant form often severely symptomatic arrhythmia, which is resistant to conventional antiarrhythmic medication. However, amiodarone and class I C antiarrhythmic drugs are frequently effective. Since medical treatment with these drugs is often successful, and AAT may resolve completely, a conservative approach is indicated in many cases.

Adolescent↗
PubMed1986

[Indications for ligation of ductus arteriosus Botalli persistens in premature infants].

Ligation of patent ductus arteriosus can be safely performed even in the smallest prematures and may be life-saving. Medical treatment with prostaglandin-inhibitors may be substituted in selected cases. From 1976-1985 a total of 215 prematures was treated. 52 of those experienced spontaneous closure. In 68 infants closure occurred following indomethacin-treatment. 48 had operation after failure of medical therapy and 53 with contraindications to indomethacin were primarily operated. The overall mortality reached 20% and was highest among those with combined medical and surgical treatment.

Birth Weight↗
PubMed1977

[Partial anomalous right pulmonary venous return into the coronary sinus without atrial septal defect (author's transl)].

Drainage of right pulmonary vein into the coronary sinus. A case of anomalous drainage of the right pulmonary vein into the coronary sinus in a boy of 6 years is presented. There was no associated atrial septal defect. Flow from the right pulmonary vein was directed into the left atrium by using a teflon patch, while maintaining coronary venous return to the right atrium.

Cardiac Catheterization↗
PubMed1976

[Heart diagnostics using M-mode echography. Continuing registration of transverse internal left ventricular diameters. II. Determination in patients with myocardial insufficiency with special reference to ischemic heart disease].

Relative Cross-sectional area Differences (RCD) and Relative mean Velocity of Contraction (RVC) are easily, quickly and precisely determined by means of impulse-reflected ultrasound. They were recognized to be highly invariant under physiological conditions and thus were considered as sensitively regulated heart-dynamic-parameters. (his paper reports about a total of 395 examinations on patients with myocardial disease and on normal subjects. Various pathogenic factors are included excepting patients with myocardial infarction. In all subgroups there is a decrease of RCD and RVC with increasing degrees of cardiac disease. Correlating the angiocardiographically determined left-ventricular ejection fraction with both parameters, they show a significant linear relationship. Even in clinically latent myocardial disease the echocardiographic parameters are defnitely reduced. Small changes of myocardial function, e.g. under digoxin and in different degrees of uremic heart disease with uremic cardiomyopathy, can be recognized by RCD and RVC under exclusion of extracardiac factors. Physical tests during exercise confirm the observed trends. The typical changes of the echocardiographic parameters in myocardial disease, permitting a sharp discrimination of pathologic values with their small physiological variability, identify RCD and RVC as sensitive parameters of the mechanical function of the myocardium in the range of validity that was examined. The described properties and the lack of discomfort to the patient suggest a number of important indications of this method.

Cardiomyopathies↗
PubMed1976

[Summer holiday camp for children with chronic renal disease (author's transl)].

A summer camp was organized for 31 children with chronic renal disease. One third of the patients suffered from renal insufficiency. The medical and paedagogical problems which evolved during the stay could be solved satisfactorily under relatively simple external conditions. The camp offered opportunity for the detection of hidden psychosocial and behavioral problems induced by the disease. These could be treated appropriately. The most important prerequisite for the organization of summer camps of this kind is a well-trained and coordinated team which should include a paediatric nephrologist, psychologists, teachers, dieticians and social workers.

Adolescent↗