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Biomedical subjects

K Fleischer

Publications and source records attributed to K Fleischer.

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

German rescue system--an overview.

Aim of the report is to show the structure, organisation and legal aspects of the rescue system of the Federal Republic of Germany. The laws are the basis of the rescue system in each of the sixteen federal countries. The governments of the countries delegate their tasks to the administrative districts. Several organisations like German Red Cross, the Fire Brigades; societies like Arbaite-Samariter-Bund, Johanniter-Unfall-Hilfe, Malteser-Hilfsdienst take part in the rescue system with a great number of paid professional people and volunteers with a more or less professional education. Who is Who in the rescue system? Who is responsible for medical education and what is the difference between the rescue system and the "doctor on emergency call"? Both systems exist side by side, but they are very different from one another. The "doctor on emergency call" is private organised by the board of general practitioners and is responsible for "all day" emergency cases on weekends and during the night. The task of the countries and districts is to care for the rescue services, and they should only be used for severe injuries and illness. Most of the physicians taking part in the rescue services belong to hospitals and have no financial interests in their duty.

Emergency Medical Services↗
PubMed1996

[Acute organic psychosis after malaria tropica].

Neuropsychiatric complications in the course of plasmodium falciparum infection are usually summarized as cerebral malaria. Heterogeneous clinical symptoms, different courses and inconstant parasitemia, however, suggest different pathogenic mechanisms. We report a case of an acute symptomatic psychosis occurring two weeks after successful therapy of a primary manifestation of plasmodium falciparum infection. The diagnosis of meningoencephalitis was based on lymphocytic pleocytosis of cerebrospinal fluid and hyperintense lesions in cranial magnetic resonance imaging. Due to the lack of plasmodium falciparum parasitemia and of serological evidence of viral infection a final diagnosis was not possible. Considering the pertinent literature, an immune-mediated complication of plasmodium falciparum infection (acute disseminated encephalomyelitis, ADEM) appears to be more probable than a direct viral or plasmodium CNS infection. We propose to reverse the term cerebral malaria for the cases with direct pathogenic influence of plasmodium falciparum, and to distinguish it from cases with possible immune-mediated pathogenesis.

Adult↗
PubMed1993

[Chronic morbidity after travel in endemic malaria regions].

Contracting malaria, especially Plasmodium falciparum infection, remains one of the main risks when non-immunes travel to the tropics. This contribution tries to describe qualitatively, and, wherever possible, quantitatively, the risk to suffer death or permanent incapacitation due to prophylaxis, disease or therapy of malaria. Roughly three million Germans annually go for a three to four weeks' trip to malaria-endemic areas. Around 700 to 1000 of them fall ill with malaria, two thirds infected with Pl. falciparum. Grossly 2% of patients expire. Lasting physical damage due to malaria (neurological sequelae after cerebral malaria, splenic rupture, impaired vision) due to therapy (cardiac side effects of chloroquine, quinine and mefloquine, acute psychoses) or due to prophylaxis (retinopathy after long-term chloroquine) are uncommon and hard to quantify. On the whole, however, well-tailored, correctly dosed prophylaxis, early diagnosis and circumspect therapy lower the risk of suffering grave health impairment due to malaria.

Antimalarials↗
PubMed1993

[Halofantrine in the treatment of imported malaria in nonimmune travelers].

The efficacy (criteria: cure rate, time to resolution of fever or absence of parasites) and safety (criteria: clinical side effects, altered laboratory parameters) of halofantrin were investigated in a multi-centre study of 96 non-immune patients (71 men, 25 women, mean age 34.3 [21-62] years) with malaria imported from regions of high resistance into Germany or Switzerland. The initial 63 patients received one-day treatment (three doses of 500 mg halofantrin), while the last 33 patients received an additional course of treatment one week later. Treatment was curative in all patients in the second group, but relapses occurred in five of the 41 patients (12.2%) with falciparum malaria who received one-day therapy. Fever resolved after a mean of 45 hours and parasites were absent after a mean of 66 hours. There were small increases in transaminase values (most probably because of the infection) in five patients, but all became normal again within a few days. Halofantrin is a safe drug and is suitable for both therapy and stand-by therapy of resistant Plasmodium infections. Treatment should be repeated after 7 days.

Adolescent↗
PubMed1992

The efficacy of halofantrine in the treatment of acute malaria in nonimmune travelers.

A multicenter prospective trial was performed to investigate the efficacy and the tolerability of halofantrine in nonimmune patients with malaria imported from areas with drug-resistant falciparum parasites (mainly Africa). Forty-five of the 74 subjects were treated with a one-day regimen (3 x 500 mg) of halofantrine, and the other 29 received the same regimen with an additional treatment on day 7. In the second group, a 100% efficacy rate was demonstrated, but in the group receiving the one-day regimen, four recrudescences were observed in patients with falciparum malaria. Only five mild adverse reactions were seen, which disappeared spontaneously after the end of the treatment. We conclude that halofantrine is highly effective in curing malaria in nonimmune subjects. The treatment scheme for such persons should include an additional treatment on day 7 for nonimmune individuals. This drug was well tolerated in our patients, indicating that halofantrine will be useful in the treatment of multidrug-resistant malaria in nonimmune persons.

Acute Disease↗
PubMed1991

Neuropsychiatric side effects after the use of mefloquine.

This study describes neuropsychiatric side effects in patients after treatment with mefloquine. Reactions consisted mainly of seizures, acute psychoses, anxiety neurosis, and major disturbances of sleep-wake rhythm. Side effects occurred after both therapeutic and prophylactic intake and were graded from moderate to severe. In a risk analysis of neuropsychiatric side effects in Germany, it is estimated that one of 8,000 mefloquine users suffers from such reactions. The incidence calculation revealed that one of 215 therapeutic users had reactions, compared with one of 13,000 in the prophylaxis group, making the risk of neuropsychiatric reactions after mefloquine treatment 60 times higher than after prophylaxis. Therefore, certain limitations for malaria prophylaxis and treatment with mefloquine are recommended.

Adult↗
PubMed1990

Serologic evidence of human immunodeficiency virus infection of the central nervous system in African patients with acquired immunodeficiency syndrome.

The intrathecal synthesis of antibodies to human immunodeficiency virus (HIV) was determined by 3 different immunoassays in 15 African patients with pre-acquired immunodeficiency syndrome (AIDS) and AIDS. Isoelectric focusing together with affinity-mediated immunoblot were found to be superior to enzyme-linked immunosorbent assay and Western blot in providing information not only about the antigen specificity of locally produced antibodies but also about their clonal distribution. In 9 of the subjects, HIV-specific oligoclonal bands were demonstrable with higher frequency or intensity in the cerebrospinal fluid than in the autologous serum, indicating autochthonous synthesis of HIV-related antibodies.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Evaluation of seroepidemiological associations between HIV-infection, hepatitis B and other sexually transmitted diseases in African patients.

To assess the possible role of sexually transmitted diseases as cofactors for the spread of AIDS, 248 adult patients were tested for the presence of antibodies against human immunodeficiency virus (HIV), hepatitis B virus (HBV) and syphilis. The survey was conducted in a hospital at Kagondo, Kagera Region, Northwest Tanzania, Africa. Subjects were randomly chosen from the outpatient clinic to include those with and without sexually transmitted diseases, as well as AIDS/pre-AIDS patients. The data were univariately and multivariately analysed by linear logit models, including interactions of demographic parameters. The results obtained reveal a strong association between the presence of antibodies against HIV, syphilis and HBV, respectively. The HBV/HIV-correlation remained stable in the multivariate analysis including interactions of social parameters, in contrast to the syphilis/HIV-correlation. We assume that this reflects the lower virulence of HBV as compared to that of syphilis. The prevalence of anti-HBV antibodies seems to be a more reliable marker for high sexual activity than those against syphilis. The possibility that HBV and HIV act as cofactors for each other's transmission could not be ruled out.

Acquired Immunodeficiency Syndrome↗