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Biomedical subjects

K Gerlach

Publications and source records attributed to K Gerlach.

At least 19 recordsLinked to original sources
PubMed2007

[Influence of negative coping style on post-operative pain reporting and pain-related behaviour].

OBJECTIVE: The aim of the study is to show whether negative coping style has an impact on post-operative pain reporting and pain-related behaviour. METHODS: After informed consent 48 gynaecological patients were enrolled in the study. Negative coping style was assessed by using the stress coping questionnaire SVF-78 (Janke and Erdmann). Patients were dichotomised by scores of the negative coping style. Pain reporting concerned pain intensity and pain quality. Pain-related behaviour was assessed by patient-controlled analgesia (PCA). Pain intensity and pain quality were assessed prior to surgery and 24 h after surgery. Patient-controlled analgesia was recorded up to 24 h after surgery. Trait anxiety (STAI-X2) was used as a control variable. RESULTS: Patients with high scores in negative coping style report increased levels of pain in both affective and sensory pain perception. At the same time patient-controlled analgesia is used less frequently by this group. This result remains significant considering trait anxiety as a covariate. CONCLUSIONS: High negative coping style may cause a discrepancy between pain reporting and pain-related behaviour. This should be taken into account in the perioperative care of patients.

Adaptation, Psychological↗
PubMed2005

[Examination of victims of sexual violence--the problem of false reports].

Some people claim to be victims of sexual violence and abuse the judicial system by filing a false police report. Generally, motivation for such behaviour is assumed to be that the self-proclaimed victims try to avoid taking responsibility for a sexual act in which they have been an active, willing participant. Concise motivations include attempts to mask a sexual affair from a partner, or to mask a first sexual intercourse by pretending to be the victim of an act of violence. By the nature of many judicial systems that are abused for such purposes, clinical forensic specialists are confronted with such cases far more often than clinical doctors not serving judicial authorities. In adults, history, injuries and other findings often show patterns that can be recognized as evidence of deception or as signs for self-inflicted injury for the trained specialist. This is far less often the case in infants and children.

Crime Victims↗
PubMed2003

[Reliability and validity of the Anaesthesiological Questionnaire for electively operated patients].

OBJECTIVE: The Anaesthesiological Questionnaire (ANP) is a self-rating method for the assessment of postoperative complaints and patient satisfaction. The questionnaire consists of two parts. Part 1 assesses the intensity of symptoms regarding the postoperative period in the "recovery-room and the first hours on the ward" (19 items) and the "current state" (17 items). Part 2 assesses patient satisfaction with the anaesthetic care as well as the unspecific perioperative care and postoperative convalescence. The questionnaire was designed to fulfill the criteria of reliability and validity and to serve as a practicable means of auditing the quality of routine clinical practice. METHODS: A total of 1,112 patients older than 18 years completed the questionnaire after an elective operation. Additionally data concerning the type of anaesthesia were recorded from the anaesthesia chart. To determine retest-reliability, 94 patients competed the ANP twice postoperatively. RESULTS: The participants of the survey represented 74.6% of the total collective. Out of 19 items 16 had a retest-reliability of r(tt)>0.70, the 3 other items had a reliability of r(tt)>0.50. Reliability (Cronbach's Alpha) of the patient satisfaction scales was between r(tt)=0.76 and r(tt)=0.91. In relation to the period immediately after anaesthesia,women reported more postoperative complaints than men but no differences were found between male and female patients with regard to satisfaction with perioperative care. Younger patients (18-49 years old) described more postoperative complaints than older patients and a lesser degree of satisfaction with perioperative care. There were plausible differences in postoperative complaints between patients who received general vs. regional anaesthesia. Patients reported less postoperative complaints after TIVA than after volatile anaesthetics. The configuration of patient characteristics and anaesthesia gives indications to "risk groups" who predominantly suffer after anaesthesia. CONCLUSIONS: The Anaesthesiological Questionnaire (ANP) is a reliable and valid method for the assessment of postoperative complaints and patient satisfaction.

Adolescent↗
PubMed2003

Postoperative analgesia after preincisional administration of remifentanil.

AIM: The aim of this study was to assess postoperative analgesia after preincisional and postincisional administration of remifentanil. METHODS: Randomized trial, 24 hours. SETTING: University hospital, hospitalized care. PATIENTS: 48 adult patients scheduled for lumbar vertebral surgery. INTERVENTIONS: in group R5, patients received an infusion of 0.2 microg kg(-1) min(-1) remifentanil over 5 minutes, followed by a break of 15 minutes before anesthesia was started. Anesthesia was induced by infusion of 0.25 microg kg(-1) min(-1) remifentanil and a bolus of 1.5 microg kg(-1) propofol, followed by a continuous infusion of 2 to 3 microg kg(-1) h-1 propofol and 0.25 microg kg(-1) min(-1) remifentanil until end of anesthesia. In group R20, patients received 0.05 microg kg(-1) min(-1) remifentanil over 20 minutes before the induction of anesthesia. In group RL, anesthesia was induced and maintained with propofol. After surgery began, a remifentanil infusion of 0.5 microg kg(-1) min(-1) was given for 50 minutes, then reduced to 0.25 microg kg(-1) min(-1). The total remifentanil doses were similar in the 3 groups. MEASURES: patients used patient-controlled analgesia (piritramide) for postoperative pain management. They recorded pain on a numeric rating scale every half hour. STATISTICS: Kruskal-Wallis test, pairwise Mann-Withney U-test, orthogonal polynomials (pain scores). RESULTS: PATIENTS given postincisional remifentanil (RL) had the slowest decrease in postoperative pain scores (p<0.01) and the highest cumulative piritramide consumption (p<0.08). CONCLUSION: The preincisional administration of remifentanil followed by a continuous infusion of 0.25 microg kg(-1) min(-1) appears to reduce pain scores and piritramid consumption when compared with a postincisional regimen.

Adult↗
PubMed2003

Remifentanil-propofol versus sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial.

BACKGROUND AND OBJECTIVE: Remifentanil has unique pharmacokinetics that might allow faster recovery after neurosurgery. We investigated the effects of a propofol/sufentanil versus a remifentanil/propofol regimen on the primary end-point tracheal extubation time. METHODS: In the Neurosurgery Department of a University Hospital, 36 patients awaiting craniotomy for supratentorial tumour resection were randomly assigned to one of two study groups. In the sufentanil/propofol group, anaesthesia was induced with 0.5 microg kg(-1) sufentanil and 1-2 mg kg(-1) propofol. Propofol infusion and boluses of sufentanil were administered for maintenance. In the remifentanil/propofol group, anaesthesia was started with an infusion of remifentanil (0.2-0.35 microg kg(-1) min(-1)) and a bolus of propofol (1.5-2 mg kg(-1)). Patients received a propofol infusion and a remifentanil infusion for maintenance of anaesthesia. Recovery times were taken from cessation of the propofol infusion. In addition, data about self-reported nausea and vomiting, pain and analgesic requirements were collected. RESULTS: Patients in the remifentanil/propofol group were extubated earlier (mean times 6.4 (+/- SD 4.7) versus 14.3 (+/- 9.2) min; P = 0.003). The two groups were similar with respect to postoperative nausea and vomiting, and patient-reported pain scores. Fifty per cent of the remifentanil/propofol patients and 88% of the sufentanil/propofol patients required no analgesics within 1 h after operation (P = 0.03). CONCLUSIONS: The remifentanil/propofol regimen provided quicker recovery. The two regimens were similar in terms of postoperative nausea and vomiting and patient-reported pain scores, but patients in the remifentanil/ propofol group required more analgesics within 1 h postoperatively.

Aged↗
PubMed2002

Accuracy of point-of-care-testing (POCT) for determining hemoglobin concentrations.

BACKGROUND: While point-of-care testing (POCT) is being used increasingly as a basis for deciding on perioperative erythrocyte transfusion, no valid standards currently exist concerning the accuracy of Hb concentration measurements. For clinical employment, however, the confidence limits (+/-2 SD) of these measurements should lie close to 5 g/l. The aim of the present study was to evaluate the accuracy and precision of point-of-care testing for blood hemoglobin concentration (cHb in g/l) measurements in critically ill patients. METHODS: Fifty blood samples from 50 postoperative patients requiring intensive care treatment were withdrawn from a cannula in the radial artery into a 2-ml heparinized syringe (containing wet sodium heparinate in the conus), in a 2-ml Monovette with 50 IE lithium heparinate, and into a 2.7-ml cuvette with 1.6 mg potassium EDTA/ml blood. The POCT battery consisted of two blood gas analyzers (ABLTM 625 and 725, Radiometer, Copenhagen), the HemoCue system (Mallinckrodt Medical, Germany), and an automated hematology analyzer (M-2000(R), Sysmex, Germany). The cyanmethemoglobin method served as the reference 'gold standard' procedure. The blood gas analyzer and HemoCue systems were tested using dry and wet heparinized blood samples. RESULTS: Hemoglobin concentrations of the reference measurements ranged from 73.9 to 159.4 g/l. The automated hematology analyzer method did reveal a small but systematic deviation for higher cHb values. For the blood gas analyzer and HemoCue system procedures there was no systematic deviation of bias for either the first measurement or the averaged data. Bland & Altman analysis revealed a larger scattering for the wet heparinized samples. CONCLUSIONS: The above-stated requirement for POCT systems, i.e. that the confidence limits should lie close to 5 g/l cHb, held true for the dry heparinized samples of the blood gas analyzer (1st measurement and mean of 2), the HemoCue system (mean of 3) and the automated hematology analyzer.

Blood Gas Analysis↗
PubMed2002

Remifentanil-clonidine-propofol versus sufentanil-propofol anesthesia for coronary artery bypass surgery.

OBJECTIVE: To compare a remifentanil-clonidine-propofol regimen with conventional sufentanil-propofol anesthesia. DESIGN: Randomized, nonblinded trial. SETTING: A single university hospital. PARTICIPANTS: Male patients scheduled for coronary artery bypass graft (CABG) surgery. INTERVENTIONS: In the control group, anesthesia was induced with 0.5 microg/kg of sufentanil and 0.2 to 0.3 mg/kg of etomidate after preoxygenation. Propofol (50 to 100 microg/kg/min) and sufentanil (0.5 to 1.0 microg/kg/h) were started after endotracheal intubation. Sufentanil was stopped after aortic decannulation. In the remifentanil-clonidine group, anesthesia was started with remifentanil (0.15 to 0.3 microg/kg/min), followed by etomidate (0.2 to 0.3 mg/kg). Propofol was started at 50 to 100 microg/kg/min, and after endotracheal intubation, clonidine infusion was started (6 to 20 microg/h). Patients received piritramide (0.15 mg/kg) and metamizole (20 mg/kg) for transitional analgesia. In both groups, propofol infusion was reduced to 30 to 60 microg/kg/min at skin closure and stopped when assisted spontaneous breathing led to adequate gas exchange. MEASUREMENTS AND MAIN RESULTS: The main outcomes were recovery times; somatic variables; plasma catecholamine levels; and self-recorded pain, nausea, and vomiting. Patients in the remifentanil-clonidine group were extubated earlier and had lower plasma epinephrine and norepinephrine levels. After transitional analgesia, the remifentanil-clonidine patients had similar postoperative analgesic use and self-reported pain and side-effect scores. CONCLUSION: Compared with a sufentanil-propofol regimen, an anesthetic regimen for CABG surgery that combines remifentanil, clonidine, and propofol provides similar hemodynamics. The remifentanil-clonidine regimen reduces catecholamine levels and hastens recovery from anesthesia.

Adjuvants, Anesthesia↗
PubMed2002

Application of consumer protection authority in preventing tobacco sales to minors.

In the USA, the enforcement of state sales of tobacco products to minors laws has had only limited impact upon reducing youth access. The application of consumer protection authorities by state attorneys general to alter the sales and promotion practices of tobacco retailers provides a complementary and highly leveraged strategy to increase compliance with tobacco sales to minors laws.

Adolescent↗
PubMed2001

A practical synthesis of (+)-discodermolide and analogues: fragment union by complex aldol reactions.

A practical stereocontrolled synthesis of (+)-discodermolide (1) has been completed in 10.3% overall yield (23 steps longest linear sequence). The absolute stereochemistry of the C(1)-C(6) (7), C(9)-C(16) (8), and C(17)-C(24) (9) subunits was established via substrate-controlled, boron-mediated, aldol reactions of the chiral ethyl ketones 10, 11, and 12. Key fragment coupling reactions were a lithium-mediated, anti-selective, aldol reaction of aryl ester 8 (under Felkin-Anh induction from the aldehyde component 9), followed by in situ reduction to produce the 1,3-diol 40, and a (+)-diisopinocampheylboron chloride-mediated aldol reaction of methyl ketone 7 (overturning the inherent substrate induction from the aldehyde component 52) to give the (7S)-adduct 58. The flexibility of our overall strategy is illustrated by the synthesis of a number of diastereomers and structural analogues of discodermolide, which should serve as valuable probes for structure-activity studies.

Aldehydes↗
PubMed2001

[Comparison of severity of chronic pain in patients differing in pain diagnosis: an analysis by means of the Mainz Pain Staging System].

INTRODUCTION: Testing the validity of the Mainz Pain Staging System (MPSS) is often carried out by pain classification according to chronic stage. It is assumed that pain syndromes distribute equally over the chronic stages. This analysis was carried out to answer three questions: Do different pain syndromes vary in chronicity, do the four axes of the MPSS differ between pain syndromes, and are there any specific item responses with respect to a pain syndrome? METHODS: 406 patients with different pain diagnoses were included in this analysis. Patients were chosen from the PAIN-Documentation-System of the pain outpatients' department of the Medical University of Luebeck. The pain score according to MPSS had been assessed, and a diagnosis attributed according to the Multidimensional Classification of Pain (MASK). RESULTS: Pain diagnoses do differ in pain chronification. Patients with headache showing the lowest chronification, and patients with back pain describing the most severe chronification, formed the extreme patient groups. Further analysis using the axes of the MPSS demonstrate different sensitivity with respect to pain syndromes, i. e. intake of drugs being the least sensitive and aspects of time being the most sensitive axes. Statistical analysis using configural frequency analysis indicated a relation between pain syndromes and specific item responses. CONCLUSION: Using pain stages of the MPSS as an experimental factor in studies of pain, it is imperative either to control pain syndromes or to confine to a single pain syndrome, to avoid confusion between pain syndromes and severity of pain chronification.

Chronic Disease↗
PubMed2001

Emergency medical service transport-induced stress? An experimental approach with healthy volunteers.

This randomized controlled trial was designed to evaluate the effects of simulated emergency medical service (EMS) transport related stress on hemodynamic variables, and catecholamine plasma levels. A total of 32 healthy male volunteers were randomized to being carried by paramedics from a third-floor apartment through a staircase with subsequent high-speed EMS transport with lights and sirens (stress; n = 16); or sitting on a chair for 5 min, and lying on a stretcher for 15 min (control; n = 16). Blood samples and hemodynamic variables were taken in the apartment before transfer, at the ground floor, and at the end of EMS transport in the stress group, and at corresponding time points in the control group. The stress versus control group had both significantly (P < 0.05) higher mean +/- SEM epinephrine (71 +/- 7 versus 37 +/- 3 pg/ml), and norepinephrine (397 +/- 29 versus 299 +/- 28 pg/ml) plasma levels after transport through the staircase. After EMS transport, the stress versus control group had significantly higher epinephrine (48 +/-6 versus 32 +/- 2 pg/ml), but not norepinephrine (214 +/- 20 versus 264 +/- 31 pg/ml) plasma levels. Heart rate increased significantly from 72 +/- 2 to 84 +/- 3 bpm after staircase transport, but not during and after EMS transport. In conclusion, volunteers being carried by paramedics through a staircase had a significant discharge of both epinephrine and norepinephrine resulting in increased heart rate, but only elevated epinephrine plasma levels during EMS transport. Transport through a staircase may reflect more stress than emergency EMS transport.

Adult↗
PubMed2001

Intubating laryngeal mask airway, laryngeal tube, 1100 ml self-inflating bag-alternatives for basic life support?

Insufficient oxygenation, ventilation and gastric inflation with subsequent regurgitation of stomach contents is a major hazard of bag-valve-face mask ventilation during the basic life support phase of cardiopulmonary resuscitation (CPR). The European Resuscitation Council has recommended smaller tidal volumes of approximately 500 ml as an effort to reduce gastric inflation; furthermore, the intubating laryngeal mask airway and the laryngeal tube have been recently developed in order to provide rapid ventilation and to secure the airway. The purpose of our study was to examine whether usage of a newly developed medium-size self-inflating bag (maximum volume, 1100 ml) in association with the intubating laryngeal mask airway, and laryngeal tube may provide adequate lung ventilation, while reducing the risk of gastric inflation in a bench model simulating the initial phase of CPR. Twenty house officers volunteered for our study. When using the laryngeal tube, and the intubating laryngeal mask airway, respectively, the medium-size (maximum volume, 1100 ml) versus adult (maximum volume, 1500 ml) self-inflating bag resulted in significantly (P<0.05) lower mean+/-S.E.M. lung tidal volumes (605+/-22 vs. 832+/-4 ml, and 666+/-27 vs. 887+/-37 ml, respectively), but comparable peak airway pressures. No gastric inflation occurred when using both devices with either ventilation bag. In conclusion, both the intubating laryngeal mask airway and laryngeal tube in combination with both an 1100 and 1500 ml maximum volume self inflating bag proved to be valid alternatives for emergency airway management in a bench model of a simulated unintubated cardiac arrest victim.

Adult↗
PubMed2000

[Intraoperative management of unexpected arterial hypotension during lumbar diskectomy].

An anesthesiological management is difficult in surgical procedures in which the operative situs is not to be seen by the anesthesist. Therefore specific knowledge of the operative procedure and related hazards are mandatory for optimal anesthesiological care. By describing the anesthesiologic proceduces in two lumbar discectomys, the specific problems in recognition and treatment of severe injuries of retroperitoneal vascular structures are explained. In addition, the differential diagnosis of intraoperative arterial hypotension is described. The communication between all disciplines involved is mandatory, especially in cases of severe complications. The management of such complications can only be solved through in-time interdisciplinary cooperation of all involved disciplines.

Aged↗
PubMed1999

Immunotherapy of human tumors with T-cell-activating bispecific antibodies: stimulation of cytotoxic pathways in vivo.

Bispecific monoclonal antibodies (Bi-mAbs) specific for a tumor-associated antigen and the CD3 or CD28 antigen on T lymphocytes represent one of the most successful experimental strategies for the immunotherapy of cancer. We report that the in vivo administration of both alpha-CD3/CD30 and alpha-CD28/CD30 Bi-mAbs results in the specific activation of xenotransplanted, resting human T cells infiltrating the CD30-positive Hodgkin's tumor. Bi-mAb treatment resulted in enhanced expression of cytokines such as interleukin 1beta, interleukin 2, tumor necrosis factor type alpha, and activation markers including Ki-67, CD25, and CD45RO in tumor-infiltrating lymphocytes. This antigen-dependent, local T-cell stimulation led to the activation of the cytolytic machinery in T lymphocytes, determined by the up-regulation of mRNA-encoding perforin and the cytotoxic serine-esterases granzymes A and B. The Bi-mAb-induced generation of CTLs depended on the presence of the CD30 antigen and the combined application of both Bi-mAbs. Our findings suggest that the combined application of T-cell-activating Bi-mAbs is able to achieve a tumor site-specific activation of the T-cell cytolytic machinery in vivo. The fact that these cytotoxic cells do not home in tumor-associated antigen-negative tissue and do not enter circulation might explain our previous observations (C. Renner et al., Blood, 87: 2930-2937, 1996) of a high cure rate in preclinical models even at an advanced stage of disease.

Animals↗
PubMed1999

EB/RP gene family encodes tubulin binding proteins.

Mutations in the adenomatous polyposis coli (APC) gene are linked to the dysplastic transformation of colorectal polyps and represent an early step in the development of colorectal tumors. Ninety-four percent of all mutations result in the expression of a truncated APC protein lacking the C-terminal region. The C-terminal region of the APC protein may have a tumor suppressor function as its absence appears to be linked to the development of dysplastic lesions. Recently, we discovered and characterized a protein called RP1 which binds specifically to the C-terminal region of the APC protein. We show now that RP1 and the other known members of the EB/RP family (EB1 and RP3) also bind directly to tubulin, both in vitro and in vivo. Immunohistochemical analyses reveal a distinct staining pattern during interphase as well as an association of RP1/EB1 with mitotic microtubule structures. The previously described puncta of the APC protein at the leading edge of membrane protrusions contact microtubule fibers that contain RP1 or EB1.

Adenomatous Polyposis Coli↗