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K Ellinger

Publications and source records attributed to K Ellinger.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Prehospital management of emergency patients after previous treatment by general practitioners--a prospective study].

INTRODUCTION: In Germany emergency patients are currently treated both by certified emergency physicians as well as by family doctors and general practitioners. METHODS: 1.) We evaluated the cooperation between the regional rescue service centres of the general practitioners' acute response service and the EMS system in Baden-Württemberg, a German "Land" (province), with about 10 million inhabitants. 2.) We analysed the management of patients who had been initially treated by the general practitioners' acute response service or by family doctors and had then to be further stabilised by the emergency physicians of our mobile intensive care unit (MICU). RESULTS: 1.) Joint rescue service centres of the two organisations exist in only 12 of a total of 37 areas. Although lacking adequate emergency equipment, practitioners often treat vitally compromised patients without the assistance of the EMS system. 2.) 97 out of 105 jobs were further analysed (acute response service: n = 45; family doctors: n = 52). Suspected myocardial infarction (n = 32) and acute heart failure (n = 15) were the most common emergencies. Emergency management before the emergency physician arrived often did not meet common standards (lack of ECG monitoring, oxygen treatment, venous access, pain relief). Until the emergency physician arrived 40% of the patients had been left alone by their doctor. Moreover, medical documentation had to be classified as insufficient in 70%. CONCLUSIONS: Prehospital treatment of medical emergencies is impeded by the lack of cooperation between the involved organisations. Family doctors and general practitioners should not treat emergencies without the help of the local MICU. Solutions of these problems are presented.

Documentation↗
PubMed1996

[New airbag-associated injuries in traffic accidents].

Experimental studies have shown that in traffic accidents with frontal impact the new airbag system can significantly reduce the incidence of severe injuries and fatal outcome. The question of whether the airbag itself induces specific patterns of injury needs further investigation. Two cases of traffic accidents with airbag protection are presented here. The first case report clearly shows the life-saving and injury-reducing effect of the airbag system in a traffic accident with frontal impact at 100 km/h. In the second case only minor injuries of the face were diagnosed initially. Hemodynamic instability occurred after 3 h of hospitalization due to rupture of the azygos vein. Analysis of the presented cases shows that, besides the well-known benefits, there are certain injury patterns that seem to be related to the use of airbags. These have not been described before. It is concluded that patients who were involved in traffic accidents with airbag deployment have to be hospitalized and followed up carefully over time, even though they are initially stable, as potentially fatal sequelae of deceleration trauma can occur later. In our opinion it is not possible to estimate the severity of airbag-associated injuries with conventional methods.

Accidents, Traffic↗
PubMed1996

Active compression-decompression cardiopulmonary resuscitation--instructor and student manual for teaching and training. Part I: The workshop.

In an attempt to standardize the teaching and training of active compression-decompression cardiopulmonary resuscitation (ACD-CPR), a group of leading emergency physicians, cardiologists, anesthesiologists, paramedics and nurses with practical, theoretical, educational, and scientific experience in the subject met in June 1995. The group was called The International Working Group of Teaching and Training Active Compression-Decompression CPR. The group was 'born' as a result of the first International Conference of Active Compression-Decompression CPR held in Copenhagen in March 1995. The following paper describes the background, development and text of and ACD-CPR course manual for both students and instructors.

Cardiopulmonary Resuscitation↗
PubMed1996

Active compression-decompression cardiopulmonary resuscitation does not improve survival in patients with prehospital cardiac arrest in a physician-manned emergency medical system.

OBJECT: To examine the efficacy of a new method of cardiac resuscitation, active compression-decompression cardiopulmonary resuscitation (ACD CPR), in prehospital cardiac arrest. DESIGN: Prospective, randomized, controlled trial. SETTING: Physician-manned Mobile Intensive Care Unit (MICU) of a university hospital, serving a population of 200,000. PARTICIPANTS: Adult patients with prehospital nontraumatic cardiac arrest treated by the MICU. INTERVENTIONS: Patients were randomized to standard chest compression according to American Heart Association (AHA) recommendations (group 1, 30 patients) or to the new technique (group 2, 26 patients). ACD was performed by use of a hand-held suction device. In both groups, advanced life support was performed as recommended by the AHA. MEASUREMENTS AND MAIN RESULTS: Rate of patients regaining a spontaneous circulation (ROSC), hospital discharge rate, and mean carbon dioxide content during resuscitation were recorded. ROSC rates in groups 1 and 2 were 40% and 38.5%, respectively. Four patients (13.3%) in group 1 and three patients (11.5%) in group 2 were discharged (group 1 v group 2: n.s.). Anatomic conditions precluded the application of ACD CPR in 5 patients. The new technique was found to impose greater physical efforts than STD CPR. Capnography was performed in 23 patients (mean value: STD CPR: 11.9 +/- 4.7 mmHg, ACD CPR: 13.7 +/- 4.9 mmHg [n.s.]). CONCLUSIONS: ACD CPR did not improve, outcome and practical performance was complicated. Therefore, this technique should not be performed routinely, or without strict supervision in prehospital cardiac arrest.

Adult↗
PubMed1995

[Preclinical control of intubation and artificial respiration. Animal experiment and literature review].

Oesophageal malposition of an endotracheal tube is among the leading causes of anaesthesia incidents. While clinical manoeuvres for detection of tube malposition are unreliable, monitoring (i.e. capnography) can prevent such incidents. The problem is particularly important in prehospital care, where capnography is not (yet) widely available. We tested three devices used for differentiating oesophageal from endotracheal intubation: 1. Non-CO2-dependent Oesophageal Detector Device (ODD) as described by Pollard and Wee, 2. Semi-quantitative chemical disposable capnometer EasyCAP (Nellcor), 3. Non-quantitative infrared miniaturised capnometer MiniCAP (MSA). METHODS. 50 anaesthetised minipigs were intubated with a Magill tube. An identical additional tube was placed in the oesophagus. The cuffs of both tubes were inflated. Unexperienced personnel (students, laboratory technicians) were asked to determine the position of one of the tubes by using one of the devices according to the randomisation plan. The decision had to be taken within 30 s. Using the ODD, the proband first injected 100 ml air into the lung (or stomach) and then tried to aspirate the same volume. EasyCAP and MiniCAP were used according to manuals. RESULTS. Each device was used 25 times with a tracheal tube and 25 times with an oesophageal tube. All tube position identifications were correct. When ventilating the oesophagus/stomach for capnometric control, regurgitation into the tube occurred six times (five times with the EasyCAP and once with the MiniCAP). In these cases, the decision was based on this occurrence and not on the display of the device. While using the ODD no regurgitation occurred. CONCLUSION. These devices are useful for preclinical practice. According to the literature and our experience, the ODD is superior for the initial control of tube position, especially in cardiac arrest. Capnometry is needed, however, for continuous control of ventilation.

Anesthesiology↗
PubMed1995

Optimal preoperative titrated dosage of hypertonic-hyperoncotic solutions in cardiac risk patients.

Hypertonic-iso/hyperoncotic solutions have been the subject of numerous studies, mostly used in a fixed dosage (4 mL/kg bw or 250 mL). Nearly no study exists to prove whether this is the appropriate dosage especially in cardiac risk patients with accompanying diseases. We have compared preoperative volume loading with either 10% hydroxyethyl-starch/7.5% NaCl (HHT-HES) or 10% hydroxyethyl-starch/.9% NaCl (HES) in 50 mL bolus infusions. Volume loading was done with either HES or HHT-HES in 2 x 20 patients before aortic aneurysmectomy. The endpoint of stepwise infusion represented the highest cardiac index (CI) at the lowest possible wedge pressure (PCWP) (turning point of each individual Frank Starling relation). 167.5 mL (+/- 45.5 mL = 2.41 mL/kg bw) of HHT-HES and 440 mL (+/- 26.15 mL = 6.33 mL/kg bw) of HES were necessary. We observed a significant higher increase of the CI in the HHT-HES group. Significant increases of PCWP, pulmonary artery pressure, and central venous pressure occurred within the groups without any significant differences between the groups (p < .05). Results of the study showed: 1) The commonly used fixed dosage of 4 mL/kg bw of HHT-HES is too high in cardiac risk patients with slight hypovolemia. 2) HHT-HES should be given in an individual titration. 3) In the HHT-HES group we observed a positive inotropic effect (higher CI). 4) With the individual titration of HHT-HES no negative side effects occurred (especially no hypotension).

Aged↗
PubMed1995

Effects of hypertonic-hyperoncotic infusion on the human atrial natriuretic factor in a standardized clinical trial.

Hypertonic-hyperoncotic solutions (HHT) are presently being utilized to resuscitate patients in shock. However, so far, the effects of HHT on human atrial natriuretic factor (hANF) have not yet been investigated in a clinical trial. The effects of HHT on hANF were studied in a standardized preoperative and clinical setting in patients undergoing aneurysmectomy. Twenty-three conscious patients were included in two groups: 11 HHT and 12 HES (HHT: 7.5% NaCl/10% HES 200; HES: .9% NaCl/10% HES 200). Stepwise infusion of 50 mL was titrated preoperatively according to individual Frank-Starling relationships. Central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) were determined before, during and after volume application. hANF, cGMP were also measured before and 1, 10, 30, 60, and 120 min after administration. The volumes necessary to produce the same volume status were: 213.6 +/- 63.6 mL of HHT, 409.9 +/- 136.2 mL of HES (p < .001). The sodium load was 273.9 +/- 81.5 mmol of [HHT], 63.1 +/- 21.0 mmol of [HES] (p < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1994

[Randomized use of an active compression-decompression technique within the scope of preclinical resuscitation].

INTRODUCTION: Despite its worldwide propagation, external chest compression is of limited efficacy. Recently a new method of cardiac resuscitation, active compression-decompression (ACD), was presented. In animals and a small series of patients resuscitated within the hospital ACD proved to augment blood flow during cardiac resuscitation as a result of greater intrathoracic pressure gradients. AIM OF THE STUDY: We investigated whether ACD does provide superior survival in patients suffering from out-of-hospital cardiac arrest. METHODS: Doctors and paramedics of the mobile intensive care unit at Mannheim University Hospital were trained in the new method. 56 patients were randomly assigned to either standard chest compression according to recommendations of the American Heart Association, AHA (Group I, 30 patients) or to ACD (Group II, 26 patients). ACD was performed by use of a hand-held suction device (CardioPump, Ambu Int.). Compression (30-50 kp) and decompression (10-15 kp) were alternately applied to the patients' chest with a frequency of 80/min. Duration of compression was 50% of the cycle. In both groups advanced life support was performed according to AHA standards. RESULTS: In Group I, 40% of the patients could be resuscitated; and 13.3% were discharged from hospital. In Group II, 38.5% of the patients regained spontaneous circulation, and 11.5% of the patients were discharged. (Group I vs. Group II: n.s.). One patient in each group survived with a severe neurological deficit. ACD caused greater physical efforts than standard chest compression. Furthermore ACD was difficult to perform in patients with ventricular fibrillation once electrode gel had been used. ACD was not feasible in five patients because of large breast (four women) and kyphoscoliosis (one patient). The rate of serious complications was lower in Group II. CONCLUSIONS: Methods to verify the efficacy of ACD in dummy training should be developed. Paramedics performing ACD should relieve each other every 5 minutes. In patients resuscitated by ACD self-adhesive defibrillation paddles instead of electrode gel should be used. Modifications in the design of the CardioPump are desirable to enhance the efficacy of ACD. With regard to future multicentre trials all paramedics should be skilled in the new technique to reach more patients in a shorter period of time.

Adult↗
PubMed1993

The glycoprotein B homologue of human herpesvirus 6.

The gene for the homologue of herpesvirus glycoprotein B (gB) has been identified in the genome of human herpesvirus 6 (HHV-6), strain U1102, and the nucleotide sequence was determined. The open reading frame encodes a protein of 830 amino acids (93.2K) with the characteristics of a transmembrane glycoprotein and close similarity to the gp58/116 complex of human cytomegalovirus (HCMV). Monoclonal antibodies 2D10 and 2B9 have been shown previously to react with an HHV-6 glycoprotein of apparent M(r) 112K, and its proteolytic cleavage products of M(r) 64K and 58K. We show that both monoclonal antibodies detect prokaryotically expressed carboxy-terminal fragments of the HHV-6 gB homologue. This indicates that the HHV-6 gB homologue is probably processed by proteolytic cleavage similar to its equivalents in HCMV and various other herpesviruses.

Amino Acid Sequence↗
PubMed1992

Gene for the major antigenic structural protein (p100) of human herpesvirus 6.

A human herpesvirus 6 (HHV-6) structural protein of 100 kDa (p100) is the polypeptide most frequently and intensively reactive in immunoblotting analyses with human sera on HHV-6-infected cells or partially purified virions. The gene for p100 was identified by screening a bacteriophage lambda library with monospecific rabbit antisera. The gene codes for a polypeptide of 870 amino acids with a calculated molecular size of 97 kDa. Its amino-terminal third is weakly homologous to the immunogenic basic matrix phosphoprotein pp150 of human cytomegalovirus. Five fragments representing more than 93% of HHV-6 p100 were prokaryotically expressed. The antigenic epitopes of p100 were preliminary mapped by immunoblotting with human sera. They are located within the carboxy-terminal part which is neither homologous nor cross-reactive to pp150 of human cytomegalovirus. Availability of the gene for the immunodominant structural protein should provide tools for studies of pathogenesis by HHV-6.

Amino Acid Sequence↗
PubMed1991

Lymphadenitis and lymphoproliferative lesions associated with the human herpes virus-6 (HHV-6).

A newly described herpes virus, human herpes virus 6, (HHV-6), has been linked to exanthema subitum but beyond this its pathogenetic impact remains to be determined. A large body of evidence links it to various lymphoproliferative disorders and this study was conducted to identify forms of lymphoproliferation linked to HHV-6. We studied biopsy samples from 32 patients with disorders of the lymphatic system for the presence of HHV-6, both by polymerase chain reaction (PCR) and in-situ hybridization (ISH) methods, as well as Epstein-Barr virus (EBV) viral DNA, clonal rearrangements of the antigen receptor genes and bcl-2 genes. All the specimens were studied morphologically and a clinical follow-up of up to 4 years was obtained. Seven of the 32 patients were positive for HHV-6 DNA and the remainder were negative. Two of these HHV-6 positive specimens, both from elderly persons, showed a similar distinct histological pattern diagnosed as malignant B-cell lymphoma of high grade malignancy. Two other HHV-6-positive specimens were reactive lymphadenopathies occurring in younger adults. In addition, one further specimen with evidence of EBV-involvement was from a patient who died 3 months after biopsy with fatal infectious mononucleosis (IM). These five samples had HHV-6 DNA by PCR and ISH. Two specimens without specific histologic abnormalities showed evidence of HHV-6 only by PCR but not by ISH. Both high grade malignant lymphomas showed clonal proliferations, one of monoclonal B-cells and the other of clonal T-cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

The unique region of the human herpesvirus 6 genome is essentially collinear with the UL segment of human cytomegalovirus.

The entire genome of human herpesvirus 6 (HHV-6) strain U1102 was cloned as overlapping fragments in cosmid and plasmid vectors. Cleavage maps were constructed for the restriction endonucleases BamHI, EcoRI, NotI and SmaI. The genome of HHV-6 U1102 is a linear dsDNA of 163 kbp, consisting of a long unique 142 kbp region flanked by direct terminal repeats of 10.5 kbp. Short stretches (290 to 470 nucleotides) of DNA, four from the terminal repeats and 55 from the UL region, were sequenced and compared by computer with the known herpesvirus amino acid sequences. Homologies were found for 10 open reading frames that are scattered over the UL region of HHV-6. Their relative positions and orientations indicate that the unique region of HHV-6 is essentially collinear with the UL region of human cytomegalovirus (HCMV), but is not collinear with the other human herpesviruses. It confirms and extends earlier observations that HHV-6 is more closely related to the beta-herpesvirus HCMV, suggesting that HHV-6 may be considered as the prototype of a new beta 2-herpesvirus subgroup.

Cloning, Molecular↗
PubMed1988

Epidermodysplasia verruciformis in a patient with Hodgkin's disease: characterization of a new papillomavirus type and interferon treatment.

A new human papillomavirus (HPV) was discovered in disseminated, macular, pityriasis versicolor-like lesions on the skin of the neck, face, scalp, and pubic region of a 42-year-old male suffering from Hodgkin's disease. Histopathology revealed features characteristic of epidermodysplasia verruciformis (ev). In contrast to classical ev, the lesions were almost exclusively seen in previously irradiated and UV-exposed skin areas. Papillomavirus capsid antigen was demonstrated with the genus-specific antiserum and the patient's serum, which had IgM and IgG antibody titers. HPV DNA was isolated from biopsies and cloned into the vector pIC20H. It proved to be related to ev-associated viruses, showing 23% cross-hybridization with DNA of the closest relative HPV14. The new HPV type was named HPV46. The genome was physically mapped and colinearly aligned with HPV8 DNA to establish its gene organization. Interferon treatment of the patient did not significantly change the clinical picture nor was the concentration of viral DNA per lesion affected. However, no virus capsid antigen was detectable after starting treatment.

Adult↗
PubMed1987

[Emergency call and medical missions. A six-months' prospective clinical system analysis of the Mannheim area].

The prehospital care of emergency patients has proved to be highly efficient for traumatic and coronary care cases. The critical factor for the rescue mission is the quality of the alarming information. In a prospective 6-month study with two mobile rescue units, all rescue missions were documented in a computerized form. Times for arrival and activities, times for return, type of alarming information, type of emergency, difference between primary and final diagnosis, cases of under- and overestimation of the primary diagnosis, and outcome of external cardiopulmonary resuscitations were listed. A guiding list including medical emergency symptoms and general emergency situations for assistance in deciding to alarm the rescue unit proved to be valid. Of a total of 2151 missions, 88.7% were primary rescue missions, 10.3% failed operations, and 1% secondary missions. The timetable and frequency of operations are shown in Figs. 1 and 2. In 34% of cases simultaneous emergency calls for two different places were received. The spectrum of 1908 missions included 34.8% internal medicine, 24.7% surgery, 14% intoxication, 12% neurological/psychiatric disease, 7.5% cardiopulmonary resuscitation, 4.6% others, and 2.7% primary death (Fig. 3). In 77.6% the primary diagnosis was confirmed by the clinician. Intoxication and epilepsy were overestimated at primary diagnosis, whereas myocardial infarction were underestimated in view of further clinical development. Only in 37.6% of patients reported to be unconscious could the unconsciousness be confirmed. Of 110 patients with prehospital cardiac arrest, 38% could be resuscitated with success; 5.5% of the total could leave the hospital (Fig. 5).(ABSTRACT TRUNCATED AT 250 WORDS)

Emergency Medical Services↗
PubMed1986

[Possibilities in the use of perfusors in emergency ambulances based on the example of the IVAC injection pump model 700].

Highly efficient medicaments like catecholamines, vasodilators and antiarrhythmics require exact and safe application. So far, however, we have not been able to meet this requirement in our medical emergency service, as the appropriate dispensing equipment has not been available. Nevertheless, today potent medication must be administered during preclinical emergency care. A case report is given that shows the advantages of the use of an electronically controlled injection pump (IVAC 700) for dispensing highly efficient medicaments in emergency medicine.

Adult↗