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Biomedical subjects

K Hoffmann

Publications and source records attributed to K Hoffmann.

At least 163 records · Page 9Linked to original sources
PubMed1998

Comparison of skin atrophy and vasoconstriction due to mometasone furoate, methylprednisolone and hydrocortisone.

BACKGROUND/AIMS: Topical glucocorticoids with improved benefit/risk ratio are of great interest in dermatology, but there are very few trials directly comparing the efficacy and side-effects of these new preparations. In our study the vasoconstrictor effect and side-effects of two of these new glucocorticoids were evaluated and blanching effect was determined by two-dimensional laser scanning. METHODS: In a randomised, double blind intra-individual comparative trial, 10 subjects were treated with various glucocorticoids or drug-free vehicle. The test drugs were mometasone furoate (MF), methylprednisolone aceponate (MP) and hydrocortisone (OH-C). The preparations were tested for a period of 3 weeks with occlusion on the flexor side of the forearm. Skin thickness and vasoconstriction were determined using 20 MHz ultrasound scanning, laser Doppler scanning (LDS) and chromometry. RESULTS: No adverse effects were observed during the observation period. Only partial vasoconstriction occurred in most cases during the observation period. MP and MF produced maximal blanching between days 3 and 5 of treatment, while with OH-C clinically visible blanching did not occur. Ultrasound evaluation of skin thickness showed similar behaviour for all three steroids tested: there were no signs of skin atrophy in any of the cases. LDS evidenced hypoperfusion of a test area on the perfusion image in only a few patients and there were no significant differences between the steroids tested. On evaluation of vasoconstriction caused by the steroids tested using chromometry there was a significant difference between MF and OH-C on the L*a*b* scale (P < 0.005). Only at day 3 was a blanching effect caused by MP and MF demonstrable (a-value, P < 0.05). CONCLUSION: In summary, the synthetic steroids MF and MP presented side-effects similar to those of OH-C but much greater vasoconstrictor effect; after an application period of over 5 days under occlusion a blanching effect in our model was not demonstrable by means of chromometry. Two-dimensional laser scanning offers no advantage in the evaluation of the blanching effect in comparison to one-dimensional laser fluxmetry (LDF).

Administration, Topical↗
PubMed1998

[Treatment prognosis and discharge 2 years later. III. Berlin Deinstitutionalization Study].

In a two-year follow-up we report on discharges in a cohort of 422 middle-term and long-term inpatients and prognoses of their psychiatrists and psychologists concerning time of discharge and location, after 50% long-term patients with a present stay of more than two years and 82% of middle-term patients (stay: 6-24 months) had been discharged. More than one-third of the long-term patients could be placed in sheltered accommodation, but 42% are still referred to nursing homes. All together 68% are still in institutional settings--either as inpatients or in nursing homes. Prognoses were not very reliable concerning the time of discharge but substantial with regard to placement in sheltered accommodation. This can be interpreted as a result of successful co-operation between inpatient and community-based services.

Activities of Daily Living↗
PubMed1998

[How does the quality of life of long-term hospitalized psychiatric patients change after their discharge into the community?].

In the Berlin deinstitutionalisation study, quality of life in 134 long-term hospitalised psychiatric patients was examined twice: Discharged patients were interviewed again one year after their return to the community, whereas patients who continued to be hospitalised were reinterviewed after 1(1/2)-2 years after the first interview. Quality of life was assessed by the Berlin Quality of Life Profile. Four groups were distinguished in the analysis: 1. patients who continued as inpatients in the same hospital, 2. patients who had been referred to other hospitals, 3. patients who had been discharged after less than one year of continuous inpatient care, and 4. patients discharged after more then one year of hospital care. The four groups differed significantly in several sociodemographic and illness-related variables. Regarding the objective quality of life data, the four groups differed significantly in respect of the spheres leisure, social contacts and safety at follow-up. Discharged patients had more leisure activities, more often a "good friend", and more frequent social contacts within the last week. They had been less often victim to a crime. In a cross-sectional analysis, the four groups showed significant differences regarding subjective quality of life in the spheres accommodation and safety. In a longitudinal analysis, no group showed any significant negative changes. Positive changes were found in the group of patients formerly hospitalised for more than a year most often: satisfaction with leisure activities, with the financial situation, and with accommodation improved significantly during the follow-up period. Results show a marked and significant improvement in the objective and subjective quality of life indicators in formerly long-term hospitalised patients after discharge.

Adult↗
PubMed1998

[Consultation psychiatry in a university clinic--from the viewpoint of psychoanalytic supervision work].

In contrast to English-speaking countries, Consultant/Liaison Psychiatry has been a neglected discipline in the GFR until now. Liaison Psychiatry in particular, is hardly represented. Consultant Psychiatry confronts the psychiatrist with a wide spectrum range of problems, whereas in his further training in the GFR he is insufficiently prepared for these responsibilities. Therefore, the authors report on a model which has already been tried and tested at the University Hospital in Ulm. Based on the annual data evaluation the authors outline the different questions in psychiatric consultations which are mainly raised and required by the Medical Hospital. In most cases they can be solved in case-focussed team conferences. However, within the framework of interdisciplinary cooperation there are more complex problems solved by regular psychotherapeutic supervision meetings with the whole team. The conditions for this procedure are clearly stated and illustrated by case studies.

Germany↗
PubMed1998

[Laparoscopy in the newborn infant--indications and procedure].

UNLABELLED: The indications and technical features of minimal invasive surgery, which is of particular interest in neonates, are being discussed. Thirty-three laparoscopies had been performed as of 1997. The youngest child was 2 days old; the smallest one weighted 2150 g. The most frequent indications were clarification of cholestasis, cystic masses, pyloromyotomies and sigmoid resections. Three conversions were necessary (two choledochal cysts, splenic torsion). Complications were one postoperative incisional hernia and two rectal stenoses after sigmoid resection. CONCLUSION: Laparoscopy can even be performed in newborns and meets the requirements of minimally invasive surgery.

Equipment Design↗
PubMed1997

Analysis of the interrelations between a low-frequency and a high-frequency signal component in human neonatal EEG during quiet sleep.

It can be shown that dominant rhythmic signal components of neonatal EEG burst patterns (discontinuous EEG in quiet sleep) are characterised by a quadratic phase coupling (bispectral analysis). A so-called 'initial wave' (narrow band rhythm within a frequency range of 3-12 Hz) can be demonstrated within the first part of the burst pattern. The detection of this signal component and of the phase coupling is more successful in the frontal region. By means of amplitude demodulation of the 'initial wave' and a subsequent coherence analysis the phase coupling can be attributed to an amplitude modulation, i.e. the envelope curve of the 'initial wave' shows for a distinct period of time the same qualitative course as the signal trace of a 'lower' frequency component (0.75-3 Hz). The results were derived from six neonates (20 burst patterns for each neonate; 8 channel recordings).

Brain Mapping↗
PubMed1997

Simultaneous spike detection and topographic classification in pediatric surface EEGs.

In this study, an algorithm is introduced for the automatic detection and simultaneous topographic classification of interictal regional spike activity in pediatric surface EEG records. The algorithm is based on the classification of the topographic distribution of instantaneous power by means of a 'group' trained classifier. The results of automatic spike analysis were compared with the decisions of two experienced electroencephalographers. Four routine EEG records exhibiting (multi)regional spikes were examined. The mean selectivity for the automatic spike detector was 84.6% (mean sensitivity 88.1%, mean specificity 89.3%) and for the electroencephalographers 85.3%. All spikes detected by the algorithm were simultaneously classified according to their topographic characteristics. The results of automatic spike classification (lateralization/localization) corresponded to the results of visual analysis.

Algorithms↗
PubMed1997

Profiles of subjective quality of life in schizophrenic in- and out-patient samples.

For the use of subjective quality of life as an evaluation criterion, it should be known if measures are reliable, to what extent they are influenced by other variables and whether differences and similarities can be detected across treatment situations. Quality of life profiles (Berliner Lebensqualitatsprofil/Lancashire Quality of Life Profile) of 440 schizophrenic patients (from Berlin, Germany and from Wales, UK) were examined. Reliabilities differed between life domains and groups. The influence of other variables was moderate and varied between the groups. Several significant differences between subsamples could be shown between in-patients with a shorter present stay and out-patients. In addition, interesting similarities in profile patterns between in-patients with a longer stay (> or = 2 years) and out-patients can be found. Being admitted to a psychiatric hospital seems to have an influence on the level and structure of subjective quality of life for some time. Being in a psychiatric hospital for a longer time seems to coincide with a stabilization of level and structure of subjective quality of life. Future reports on subjective quality of life should include diagnostically homogeneous sampling and control the correlation with psychopathology. Further research is needed to clarify the impact of other variables (e.g. length of stay, cognitive variables, treatment features) on patients' satisfaction in different settings.

Adult↗
PubMed1997

[Health consciousness and risk behavior of prostitutes].

Regular examinations of prostitutes may reduce the incidence of sexually transmitted diseases in this high risk group. Therefore since April 1988 regular mandatory examinations have been offered by the regional health office in cooperation with the Department of Dermatology of the Ruhr-University of Bochum. The aim of this study was to evaluate the acceptance and efficiency of such an examination. The study was based on anonymous questionnaires. Mean age of the 80 prostitutes was 31.4; 67 of then were born in Germany. 78 of the women always used condoms, while 71 thought that condoms prevent STDs. Three women suffered from a STD in the last 12 months. The majority the women (75 from this 80 prostitutes) did not perceive the examination as discrimination, while 71 felt the examinations were of high quality. These results indicate that regular mandatory examinations should be part of health prevention care of prostitutes and that they are well accepted and tolerated by these women.

Adult↗
PubMed1997

[Balneophotochemotherapy with 8-methoxypsoralen in lichen sclerosis et atrophicus].

A 66-year-old woman with longstanding lichen sclerosus et atrophicus improved strikingly with PUVA bath photochemotherapy over a period of 6 weeks. The cumulative UVA dose was 31.7 J/cm2; the single UVA dose ranged from 0.3 to 2.3 J/cm2. After 16 treatment sessions, the sclerotic lesions had softened greatly, while after 24 treatments, the skin lesions were almost completely cleared and pruritus was diminished. Histopathological analysis of biopsy specimens from previously affected sites as well as 20 MHz ultrasound examinations showed almost no residual sclerosis. Although long-term results are not yet available, PUVA bath photochemotherapy seems to be a promising and effective new treatment modality without systemic side effects for patients with disseminated lichen sclerosus et atrophicus.

Aged↗
PubMed1997

[Keratosis palmoplantaris maculosa seu papulosa (Davies-Colley) simulating multiple cornua cutanea].

Patient with extensive keratosis palmoplantaris maculosa seu papulosa (Davies-Colley) presented with multiple cutaneous horns. The clinical picture, the histology, the electro microscopic examination, the negative tumor screening and the viral classification in the tissue allowed the differentiation from other palmoplantar keratoses. The patient was treated successfully using a combination of acitretin with physical and chemical measures.

Callosities↗
PubMed1997

[PUVA-bath photochemotherapy in Hallopeau's acrodermatitis continua suppurativa].

A 73-year-old man presented with severe, relapsing acrodermatitis continua of Hallopeau, which had been resistant to prior local and systemic therapy for eight years. The patient was treated with selective hand PUVA-bath photochemotherapy. The cumulative dose of UVA used over 10 weeks of treatment was 54.6 J/cm2 on the palms and 26.8 J/cm2 on the dorsum of the hands. The single UVA doses ranged from 0.5 to 2.5 J/cm2 on the palms and 0.2 to 1.4 J/cm2 on the dorsum of the hands. After 16 treatment sessions, the acrodermatitis continua started to improve, and after 24 treatments, had cleared completely. In the four months following the PUVA therapy, there was no relapse. PUVA-bath photochemotherapy is an efficient therapeutic alternative in the treatment of acrodermatitis continua due to its clinical effectiveness and lack of any systemic side effects. It also possesses the advantage of allowing selective photosensitization of certain areas of the skin such as the hands.

Acrodermatitis↗
PubMed1997

A 7-year-old child with primary tumour localisation in the distal duodenum--new imaging procedures for an improved diagnosis.

UNLABELLED: Duodenal gastrinomas in childhood are extremely rare and often missed at first medical consultation. We report on a 7-year-old child with sporadic gastrinoma of primary localisation in the distal duodenum. Small metastases in the liver and regional nodes were detected pre-operatively by somatostatin receptor scintigraphy (SRS) but not by other conventional imaging procedures. Diagnostic procedures include pre-operative SRS, endoscopic ultrasound and intra-operative endoscopic transillumination. CONCLUSION: Gastrinomas are rare abdominal tumours in childhood. Pre-operative tumour-specific diagnosis is possible by 111indium pentreotide SRS.

Biomarkers, Tumor↗
PubMed1997

Characterization and inhibition of beta-adrenergic receptor kinase in intact myocytes.

OBJECTIVES: beta-Adrenergic receptor kinase (beta ARK) phosphorylates and thereby inactivates agonist-occupied beta-adrenergic receptors (beta AR). beta ARK is thought to play an important role in the regulation of cardiac function. Therefore, we studied beta ARK activation and its inhibition in intact smooth muscle cells and in cardiomyoblasts. METHODS AND RESULTS: beta AR agonist-stimulated translocation of beta ARK was monitored by immunofluorescence labelling with specific antibodies and confocal laser scanning microscopy in DDT-MF 2 hamster smooth muscle cells and in H9c2 rat cardiomyoblasts. In unstimulated cells. beta ARK was mainly located in the cytosol. After beta AR agonist stimulation, the beta ARK signal was partially translocated to the membranes. Liposomal gene transfer of the COOH-terminus of beta ARK ('beta ARKmini') as a beta ARK inhibitor led to functional expression of this protein in both cell lines with high efficiency. Western blots with beta ARK antibodies showed a gene concentration-dependent immunoreactivity of the 'beta ARKmini' protein. 'beta ARKmini'-transfected myocytes demonstrated reduced membrane targeting of the beta ARK immuno-fluorescence signal. Additionally, the effect of 'beta ARKmini' on beta AR-induced desensitization of myocytic cAMP accumulation was investigated. In control cells, desensitization with isoproterenol led to a subsequent reduction of beta AR-induced cAMP accumulation. In 'beta ARKmini'-transfected myocytes, this beta AR-induced desensitization was significantly diminished, whereas normal beta AR-induced cAMP accumulation was unaffected. A gene concentration of 2 micrograms 'beta ARKmini' DNA/100,000 cardiomyoblasts, and of 0.7 microgram 'beta ARKmini' DNA/100,000 DDT-MF2 smooth muscle cells led to approximately 5.9- and approximately 5.6-fold overexpressions of 'beta ARKmini' vs. native beta ARK, respectively. These gene doses proved sufficient to attenuate beta-adrenergic desensitization significantly. CONCLUSIONS: (1) beta ARK translocation was evidenced in DDT-MF2 smooth muscle cells and in cardiomyoblasts by confocal laser scanning microscopy. (2) Feasibility of 'beta ARKmini' gene transfer to myocytes was demonstrated, and necessary gene doses for beta ARK inhibition were titered. (3) Overexpression of 'beta ARKmini' functionally interacted with endogenous beta-adrenergic signal transduction, leading to sustained cAMP accumulation after prolonged beta-adrenergic stimulation.

Adrenergic beta-Agonists↗
PubMed1997

Intracutaneous histamine injection can detect damage of cutaneous afferent fibres in postherpetic neuralgia.

BACKGROUND: The axon reflex response in diseased skin of patients with postherpetic neuralgia may be significantly impaired. OBJECTIVE: In the present study we introduced a simple test for quantifying the decreased axon reflex flare response in the clinical routine. METHODS: Histamine was intradermally applied to the diseased dermatome as well as to the corresponding dermatome of the contralateral side of the body. Ten minutes after application, skin blood flow and the extension of the hyperaemic response were assessed by means of laser Doppler scanning. RESULTS: In the skin region affected by the postherpetic neuralgia, the hyperaemic area was significantly smaller than in the healthy skin. The mean flux values did not differ significantly between the two sites. There was no correlation between the hyperaemic response and the intensity of pain sensation assessed by a clinical visual analogue score. CONCLUSION: The smaller hyperaemic area in the dermatome with postherpetic neuralgia strongly indicates a C fibre or C nociceptor damage. We consider histamine injections as a useful tool in the differential diagnosis of postherpetic neuralgia.

Aged↗
PubMed1997

[High resolution 20 MHz ultrasound diagnosis in dermatology for noninvasive imaging of malignant melanomas].

For years, high-resolution b-scan ultrasound is a well established technique in dermatology regarding the preoperative determination of thickness of skin tumors like malignant melanoma or basal cell carcinoma. Most tumors appear as echopoor areas in high-frequency sonography. Until today, a differentiation between skin tumors by means of high-frequency ultrasound is not possible. This is also true concerning the differentiation between the tumor tissue itself and its subtumoral inflammatory infiltration. Therefore, this lack of differentiation leads to the fact that sonometric thicknesses of tumors often exceed the originally measured tumor thickness in histology. By means of three-dimensional reconstruction of serial b-scan images, it is possible to determine each tumor's volume and surface as well as the topographical arrangement of echopoor areas and sonographical structures. Besides high-frequency ultrasound, additional non-invasive techniques like MRI, ultrasound- or laser-doppler, computer-aided image analysis and epiluminescence microscopy are also available for diagnosing malignant melanoma. Epiluminescence microscopy is used today as a standard technique in the diagnosis of malignant melanoma due to the possibility of differential diagnosis. Latest techniques like OCT (optical coherence tomography) are not ready yet to be applied regularly in diagnosis of tumors in the field of dermatology.

Diagnosis, Differential↗