Biomedical subjects

P Kessler

Publications and source records attributed to P Kessler.

At least 55 records · Page 3Linked to original sources

PubMed2001

[Preclinic in the hospital. In-hospital emergency and rescue service in a large hospital].

BACKGROUND AND OBJECTIVE: Many hospitals have a special resuscitation service that is responsible for life-threatening emergencies outside the hospitals intensive care unit, i.e. in the wards and in patient-treatment areas. In contrast, there is generally no emergency service caring for patients, visitors or personnel outside of these areas. In order to provide emergency medical help in the entire hospital area, in 1999 we instituted an additional in-hospital emergency service to cover the larger hospital area. This paper describes the structure of our in-hospital emergency service and our experience in the first 26 months after its establishment. PATIENTS AND METHODS: We analysed the emergency protocols of all 147 episodes, that had occurred within the first 26 months. We classified them according to type of disease and/or injury by using the NACA score (range 1 to 7) to assess the severity of disease and/or injury. RESULTS: 45 episodes took place within one of the 17 hospital buildings. 92 requests for help came from the hospital service and treatment areas including walkways and passages, while 3 came from the immediate vicinity outside of the hospital. A total of 7 requests turned out to be pranks, and 31.3% responses proved to be unnecessary when the team arrived at the scene. Of the total of 125 treated cases, 30 had a NACA score between 4 and 6, denoting life-threatening injury and/or disease. 6 patients were found dead at the scene or died shortly after arrival of the team. 101 of the patients had to be admitted to the hospital's emergency room. CONCLUSION: Since its establishment, knowledge of the existence of our in-hospital emergency service has steadily increased within the hospital community. As a consequence, number of events have likewise steadily increased. We believe that a total of 20.4% life-threatening events underscores the importance of the service in our large and extended hospital area. We also feel that our adherence to the training and personnel requirements demanded of public emergency services is necessary in order to insure the quality and efficacy of the service. This is also important because of current intentions to use our in-hospital service as a back-up and/or reserve for the community's public emergency services.

Emergencies↗

PubMed2001

Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy.

BACKGROUND: This prospective placebo-controlled trial was designed to determine whether intravenous immune globulin (IVIG) improves left ventricular ejection fraction (LVEF) in adults with recent onset of idiopathic dilated cardiomyopathy or myocarditis. METHODS AND RESULTS: Sixty-two patients (37 men, 25 women; mean age +/-SD 43.0+/-12.3 years) with recent onset (</=6 months of symptoms) of dilated cardiomyopathy and LVEF </=0.40 were randomized to 2 g/kg IVIG or placebo. All underwent an endomyocardial biopsy before randomization, which revealed cellular inflammation in 16%. The primary outcome was change in LVEF at 6 and 12 months after randomiz. Overall, LVEF improved from 0.25+/-0.08 to 0.41+/-0.17 at 6 months (P<0.001) and 0.42+/-0.14 (P<0.001 versus baseline) at 12 months. The increase was virtually identical in patients receiving IVIG and those given placebo (6 months: IVIG 0.14+/-0.12, placebo 0.14+/-0.14; 12 months: IVIG 0.16+/-0.12, placebo 0.15+/-0.16). Overall, 31 (56%) of 55 patients at 1 year had an increase in LVEF >/=0.10 from study entry, and 20 (36%) of 56 normalized their ejection fraction (>/=0.50). The transplant-free survival rate was 92% at 1 year and 88% at 2 years. CONCLUSIONS: These results suggest that for patients with recent-onset dilated cardiomyopathy, IVIG does not augment the improvement in LVEF. However, in this overall cohort, LVEF improved significantly during follow-up, and the short-term prognosis remains favorable.

Acute Disease↗

PubMed2001

Incidence of gastrointestinal complications in cardiopulmonary bypass patients.

Gastrointestinal complications after cardiac surgery are associated with a high mortality rate. Because of the absence of early specific clinical signs, diagnosis is often delayed. The present study seeks to determine predictive risk factors for subsequent gastrointestinal complications after cardiosurgical procedures. Within a 1-year period, a total of 1116 patients who had undergone open heart surgery with cardiopulmonary bypass were prospectively studied for gastrointestinal complications. To determine predictive factors, all case histories of the patients were analyzed. Of the 1116 patients, 23 (2.1%) had gastrointestinal complications during the postoperative period, 10 of whom had to undergo subsequent abdominal surgery. Of these 23 patients, 20 died. Early gastrointestinal complications, which occurred mostly on postoperative days 6 or 7, consisted of bowel ischemia or hepatic failure. Late complications were gastrointestinal bleeding, pseudomembranous colitis, cholecystitis, and septic rupture of a spleen. The relative risk for abdominal complications after cardiopulmonary bypass was highly increased in association with (1) a cardiac index less than 2.0 l/min-1/(m2)-1, (2) postoperative onset of atrial fibrillation, (3) emergency surgery, (4) need for vasopressors, (5) need for intraaortic balloon counterpulsation, and (6) need for early redo thoracotomy due to surgical complications. All patients with necrotic bowel disease had elevated serum lactate levels. Furthermore, cardiopulmonary bypass and aortic clamping times were significantly prolonged in patients who developed gastrointestinal complications. A number of predictive factors contribute to the development of gastrointestinal complications after cardiopulmonary bypass surgery. Knowledge of these factors may lead to earlier identification of patients at increased risk and may allow more efficient and earlier interventions to reduce mortality.

Aged↗

PubMed2001

[Postoperative pain therapy in pediatrics. Results of a representative survey in Germany].

The last survey addressing postoperative pain management in Germany was published in 1987, special data concerning postoperative pain management in pediatric patients had not been presented previously. The goal of this survey is to present the standard of postoperative pain management in pediatric patients in Germany. A detailed questionnaire was mailed to all German anaesthesia departments and interdisciplinary intensive care units (n = 1,500) to determine the current management of postoperative pain management in pediatric patients. After eight weeks, 42.6% of the survey had been returned. Rectally administered acetaminophen is the standard drug regimen for postoperative analgesia in children. Compared to previous surveys, the use of opioids has increased in popularity. The routine use of non-steroid antiinflammatory drugs (NSAIDs) and spasmolytics as well as the application of regional anaesthesia techniques is uncommon in pediatric postoperative pain management. Compared to other European countries, patient- or parent-controlled analgesia is more popular in Germany. Despite modern concepts of organization and a great variety of drugs available today, 71.1% of the responding anesthesiologists in this survey still believe that pediatric postoperative pain management needs to be improved.

Analgesics↗

PubMed2001

[Fiberoptic intubation during remifentanil propofol sedation].

OBJECTIVE: Fiberoptic intubation for the management of the difficult airway is usually achieved with the patient under light sedation. The goal of the present study was to evaluate the combination of propofol and remifentanil for sedation during fiberoptic intubation. METHODS: Plans were made to use fiberoptic intubation in 40 patients with predictably difficult airways. After topical anaesthesia of the pharynx with lidocaine, oxygen was administered via nasal cannula. A capnograph was attached to determine the adequacy of ventilation and an infusion of remifentanil (0.05 microgram/kg/min) and propofol (2 mg/kg/h) was started. After the first signs of sedation, nasal fiberoptic intubation was carried out. The depth of sedation was guided by clinical observation and capnographic data and the remifentanil dose was adjusted as necessary. RESULTS: All patients, including some with very severe airway anomalies, were uneventfully intubated using the regimen we have described. Nasal capnography made it possible to monitor ventilation in all patients during bronchoscopy and intubation. The onset of hypoventilation was recognized in patients and appropriately treated by adjusting the narcotic dose. No subject became hypoxic or hypercarbic during the procedure. The changes of blood pressure and heart rate exceeded the 30% range in only one patient (a 37% blood pressure increase). Sedation was rated as good to very good in 35 patients. Coughing occurred only in 5 patients and 37 out of 40 patients had no recall that intubation had occurred. CONCLUSION: Our combination of remifentanil and propofol was shown to be a safe sedation regimen for fiberoptic intubation. Monitoring ventilation via nasal capnography and arterial oxygen saturation via pulse oximetry provided sufficient patient safety.

Adjuvants, Anesthesia↗

PubMed2001

Biogenesis and function of peroxisomes and glycosomes.

Peroxisomes of higher eukaryotes, glycosomes of kinetoplastids, and glyoxysomes of plants are related microbody organelles that perform differing metabolic functions tailored to their cellular environments. The close evolutionary relationship of these organelles is most clearly evidenced by the conservation of proteins involved in matrix protein import and biogenesis. The glycosome can be viewed as an offshoot of the peroxisomal lineage with additional metabolic functions, specifically glycolysis and purine salvage. Within the parasitic protozoa, only kinetoplastids have been conclusively demonstrated to possess glycosomes or indeed any peroxisome-like organelle. The importance of glycosomal pathways and their compartmentation emphasizes the potential of the glycosome and glycosomal proteins as drug targets.

Animals↗

PubMed2001

Distraction osteogenesis of the maxilla and midface using a subcutaneous device: report of four cases.

The use of distraction osteogenesis in the hypoplastic maxilla and midface is still controversial. Since the beginning of 1998, 25 patients have been treated with osteodistraction techniques for various reasons. Among them were four patients who were treated by high LeFort I osteotomies and insertion of a newly developed subcutaneous distraction device in the malar region. Distraction osteogenesis was successful in all four cases resulting in a mean sagittal bone gain of 12.0 mm (range 7-14) at the level of distractor fixation. All patients were kept under orthodontic supervision during osteodistraction. The final occlusal relation was satisfactory. Cephalometric measurements after distraction showed an anterior rotational movement of the midface region. As the question of relapse and further growth is still not clear, Delaire masks are used to stabilize the surgical result after removal of the distractor. The importance of long-term follow-up is stressed.

Adolescent↗

PubMed2001

Continuous and intermittent bone distraction using a microhydraulic cylinder: an experimental study in minipigs.

Distraction osteogenesis of the mandible is an option in the treatment of mandibular hypoplasia. Today, only intermittent distraction devices are available for clinical application. The aim of this study in minipigs was to evaluate continuous bone distraction using a microhydraulic cylinder. After a seven-day interval, continuous or intermittent distraction of 1.5 mm/day was established for 10 days. Immediately after active distraction, two animals and 20 days later the other four animals were killed and radiographs taken. The mandible was then removed en bloc and the distracted bone examined histologically. Intermittent distraction forces of up to 2500 kPa were necessary to move the cylinders' piston. The pressure needed for continuous distraction was considerably lower (1200-1300 kPa). While the specific histological structure of the varying zones in the distraction gap was similar after continuous and intermittent distraction, bone healing was accelerated after continuous distraction as shown by ultrasonography and scanning electron microscopy.

Animals↗

PubMed2001

Histomorphometric and densitometric changes in bone volume and structure after avascular bone grafting in the extremely atrophic maxilla.

AIM: To evaluate changes in volume and structure of bone after autogenous iliac crest bone grafting to the maxilla. To discover the predictive value of computed tomographic (CT) measurements of bone density and study their correlation with the results of histomorphometric analyses of bone structure. PATIENTS AND METHODS: In 25 patients with atrophic maxillae (mean age 47 years, range 15-71), who had onlay bone grafting and sinus floor augmentation with autogenous iliac crest bone, a CT analysis was carried out immediately before and after grafting, and 5 months (range 4-6) later, at the time of endosseous implantation. On both occasions, bone biopsy specimens were taken. HISTOLOGY OF BONE: After preparing and digitizing semithin sections, histomorphometry (NH-Image) was done to establish the ratio of trabeculae to medullary cavity. CT ANALYSIS: The available transverse and vertical bone and the bone density of natural and augmented bone were analyzed using the Simplant Program and the CT data. As reference, the bone density of the first cervical vertebra was used. By regression analysis, the correlation of CT bone density and histological bone structure was investigated. RESULTS: After a median healing period of 4.5 months, no significant changes were found in bone volume compared with the measurements made immediately after grafting. The changes in density in the cancellous portion of the grafted bone showed no correlation (correlation coefficient: +0.16) with the results of histomorphometric analysis of bone structure. CONCLUSIONS: The predictive value of measurement of bone density to evaluate bone structure on the basis of the D1-D4 classification needs to be reconsidered. The most favourable time for secondary implantation is 4-6 months after iliac crest bone grafting.

Adolescent↗

PubMed2001

Langerhans cell granulomatosis: a case report of polyostotic manifestation in the jaw.

We report the case of a 43-year-old woman who suffered from a polyostotic form of Langerhans cell granulomatosis (LCG) in the mandible and maxilla. The course of the disease was followed for more than 14 years. The disease's progression finally required subtotal resection of the mandible and reconstruction with a microvascular fibula graft. The literature is reviewed for diagnostic and treatment concepts based on the different stages of LCG.

Adult↗

PubMed2001

The role of angiography in the lower extremity using free vascularized fibular transplants for mandibular reconstruction.

BACKGROUND: Fibular osteocutaneous free tissue transfer represents the work horse procedure in the reconstruction of large oromandibular defects. Before the fibula is harvested the blood supply of the lower leg and foot should be examined, as the perfusion may be based predominantly on the peroneal artery and venae comitantes. To avoid postoperative ischaemia of the lower leg, adequate perfusion must be guaranteed before sacrificing the peroneal vessels. Anatomical variations and peripheral arterial occlusive disease add to the risk of ischaemia. Various methods of evaluating the blood supply have been described. MATERIAL AND METHODS: Fifty-two consecutive cases of fibular flaps were evaluated to study the arterial blood supply of the lower extremity. For angiography, the right femoral artery was punctured using the Seldinger technique and a total of 20-25 ml contrast medium (Imeron 300) was infused and images required at a rate of 0.5/sec. RESULTS: A patent three-vessel supply to both feet could only be detected in 21 patients. Thirty-one angiograms revealed anatomic and/or arteriosclerotic alterations. Angiography provided accurate information in all patients and allowed successful fibular transfer in those patients who were found preoperatively to have regular conditions. CONCLUSION: Preoperative assessment of the blood supply of the lower extremity is important before fibular osteocutaneous free tissue transfer. We advocate angiography as interpretation is not examiner dependent.

Adult↗

PubMed2001

Prophylactically-administered rectal acetaminophen does not reduce postoperative opioid requirements in infants and small children undergoing elective cleft palate repair.

UNLABELLED: Rectal acetaminophen (Ac) is often administered prophylactically at anesthesia induction for postoperative pain management in small children and is thought to have an opioid-sparing effect. We assessed in this double-blinded, prospective, randomized study early opioid requirements after three doses of Ac (10, 20, and 40 mg/kg versus placebo) in 80 children (ASA physical status I, age 11.4 +/- 9.9 mo) undergoing cleft palate repair. Single Ac plasma concentrations were measured. Pain scores assessed in the postanesthesia care unit of > or = 4 of 10 resulted in the IV administration of 25 microg/kg piritramide, a popular European mu receptor agonist (lockout time, 10 min; maximum 0.125 mg/kg). There were no significant differences between groups with regard to the early postoperative pain scores and the overall cumulative IV opioid requirements. Maximal plasma concentrations achieved were only subtherapeutic (Ac 10 mg/kg: 8 microg/mL; Ac 20 mg/kg: 13 microg/mL; Ac 40 mg/kg: 21 microg/mL after 122, 122, and 121 min, respectively). We conclude that rectal Ac up to 40 mg/kg has no opioid-sparing effect, does not result in analgesic Ac plasma concentrations, and lacks proof of its efficacy in infants and small children undergoing cleft palate repair, whereas titrated IV opioid boluses produced rapid and reliable pain relief. IMPLICATIONS: Acetaminophen is widely used prophylactically for postoperative analgesia in children and is thought to have an opioid-sparing effect. We showed that rectal acetaminophen up to 40 mg/kg administered at anesthesia induction lacked proof of efficacy, whereas IV opioid boluses resulted in reliable pain relief in children undergoing cleft palate repair.

Acetaminophen↗

PubMed2001

Mountaineering accidents in the European Alps: have the numbers increased in recent years?

OBJECTIVE: Media reports convey the impression that the incidence of fatal accidents in the European Alps has increased. Because more specific data are lacking, we analyzed available data from the mountain rescue services in Germany, Austria, southern Tirol, Zermatt/Switzerland, and Chamonix/France from 1987 until 1997. METHODS: Information was gathered from the annual reports of the Austrian Mountain Rescue Service, the Swiss Alpine Club Rescue Station in Zermatt, the Mountain Rescue Service of the Southern Tirol Alpine Club, the Mountain Rescue Service of the Bavarian Red Cross, and the Department of Mountain Medicine and Traumatology from the Hospital in Chamonix. RESULTS: Although the total number of rescue missions and injured alpinists increased significantly during the period, the number of fatalities retrieved during such rescue missions showed no significant increase. CONCLUSIONS: Even taking into account the varying definitions of "mountain accident" used in these countries, available data from the analyzed areas of the European Alps do not demonstrate a drastic increase in the number of fatalities. In the future, data concerning mountain accidents in the European Alps should be monitored according to standard definitions and stored by the International Commission for Alpine Rescue.

Accidents↗

PubMed2001

Abdominal complications after cardiac surgery.

OBJECTIVE: Abdominal complications after cardiac surgery are associated with a high mortality rate. Due to the absence of early specific clinical signs, diagnosis is often delayed. The present study seeks to determine predictive risk factors for subsequent gastrointestinal complications after cardiosurgical procedures. METHODS: Within 12 months, all patients (n = 1,116) who had undergone open heart surgery with cardiopulmonary bypass at our institution were studied for abdominal complications. To determine predictive factors, all case histories of the patients were analysed. RESULTS: Abdominal complications occurred in 23 (2.1%) patients during the postoperative intensive care unit (ICU) stay, ten of whom had to undergo subsequent abdominal surgery. Of these 23 patients, 20 died. Early complications occurred most likely on postoperative days 6 and 7, consisting of bowel ischaemia or hepatic failure. Late complications consisted of gastrointestinal bleeding, pseudomembraneous colitis, cholecystitis and septic rupture of a spleen. The relative risk for abdominal complications after cardiopulmonary bypass was highly increased in association with a cardiac index less than 2.0 l/min-1/(m2)-1 (22.1-fold), postoperative onset of atrial fibrillation (16.6-fold), emergency surgery (10.7-fold), need for vasopressors (10.1-fold), need for intra-aortic balloon counterpulsation (8.6-fold), and the need for re-exploration within the first 24 hours (8.4-fold). All patients with necrotic bowel disease had elevated serum lactate levels. Furthermore, both cardiopulmonary bypass and aortic clamping times were significantly prolonged in patients who developed gastrointestinal complications. CONCLUSIONS: A number of predictive factors has been described to contribute to the development of abdominal complications subsequently after cardiac surgery on cardiopulmonary bypass. Knowledge of these factors may lead to earlier identification of patients at increased risk and may allow for more efficient and earlier interventions.

Abdomen↗

PubMed2001

[Systemic disease caused by the fungus Aspergillus fumigatus in immunocompromised patients].

The authors describe an invasive pulmonary Aspergillus infection in three immunocompromised patients (1x plasmacytoma, 1x autoimmune thrombocytopenia, 1x asthma bronchiale) and draw attention to the possible occurrence of this disease also in subjects without serious neutropenia. The common risk factor in all three patients was corticoid treatment. In immunocompromised patients only early adequate and sufficiently long antimycotic treatment gives hope that the infection will be controlled.

Aged↗

PubMed2001

[Autologous transplantation of peripheral hematopoietic cells and subsequent maintenance therapy with interferon alpha or interferon alpha and dexamethasone in patients with multiple myeloma--results from the 4W randomized clinical trial of the Czech Myeloma Group].

In the clinical 4W study patients with newly diagnosed multiple myeloma are included where the state of the disease calls for treatment, while high dose chemotherapy is not contraindicated. Treatment according to protocol 4W comprises induction chemotherapy VAD, mobilization of haematopoietic cells (cyclophosphamide 5 g/m2). This is followed by autologous transplantation (as a conditioning regime melfalan 200 mg/m2 is administered). The patients are randomized into two groups, the first one is given interferon alpha as maintenance treatment, in the second group alternates cyclically interferon alpha and dexamethasone treatment. So far between 1996 and Aug. 31 2000 in the 4W clinical study 167 patients were included. 113 patients after transplantation were evaluated incl. 13 (12%) who achieved complete remission of the disease (absence of paraprotein, negative immunofixation), 63 patients (56%) with remission of the disease (decline of paraprotein, by more than 75%). Another 24 patients (21%) achieved partial remission (decline of paraprotein by more than 50% but less than 75%). The peritransplantation mortality is 2.67%. So far there is no significant difference between the two groups on maintenance treatment as regards the mean period before a relapse of the disease (p = 0.567). The median of the mean survival was not reached so far. The authors describe the results of the internal analysis of data incl. statistical processing.

Adolescent↗

PubMed2001

[Tooth loss, dental restorations and dental attendance in Switzerland].

The aim of this study is to report about the dental health situation in Switzerland and to evaluate frequencies of dental visits. Data were obtained from the first and second national Health Survey of the Federal Office for Statistics in 1992/3 and 1997. Based on a random sample of the population aged from 15 to 74 years, 71% participated in an oral interviews and of this group of individuals, 75% later filled in a written questionnaire in 1992/3. Data analysis showed that the proportion of the fully dentate population (28 remaining teeth) is 41%, while almost 50% had some prosthetic treatment. 31% were treated with fixed prostheses, i.e.crowns and/or bridges, and 19% with removable prostheses, i.e. partial and/or full dentures. With increasing age the number of missing teeth and the frequency of prosthetic treatment went up. The population with prosthodontic reconstruction increased mainly in the third and forth decades. In the elderly population (age 65-74 years), a shift was observed from fixed to removable prostheses; two thirds in this groups was restored with removable prostheses. The proportion of subjects visiting the dentist was by 70% in 1992/3 and declined to 65% in 1997. Subjects wearing removable prostheses had apparently lower frequencies (43%) in dental visits than subjects with fixed prostheses (80%). A potential concern exists for the edentulous population who presented a limited need for dental visits of only 22% during the year preceding the study.

Adolescent↗

PubMed2000

Relative spatial position of a snake neurotoxin and the reduced disulfide bond alpha (Cys192-Cys193) at the alpha gamma interface of the nicotinic acetylcholine receptor.

We determined the distances separating five functionally important residues (Gln(10), Lys(27), Trp(29), Arg(33), and Lys(47)) of a three-fingered snake neurotoxin from the reduced disulfide bond alpha(Cys(192)-Cys(193)) located at the alphagamma interface of the Torpedo nicotinic acetylcholine receptor. Each toxin position was substituted individually for a cysteine, which was then linked to a maleimido moiety through three different spacers, varying in length from 10 to 22 A. We estimated the coupling efficiency between the 15 toxin derivatives and the reduced cystine alpha(192-193) by gel densitometry of Coomassie Blue-stained gels. A nearly quantitative coupling was observed between alphaCys(192) and/or alphaCys(193) and all probes introduced at the tip of the first (position 10) and second (position 33) loops of Naja nigricollis alpha-neurotoxin. These data sufficed to locate the reactive thiolate in a "croissant-shaped" volume comprised between the first two loops of the toxin. The volume was further restrained by taking into account the absence or partial coupling of the other derivatives. Altogether, the data suggest that alphaCys(192) and/or alphaCys(193), at the alphagamma interface of a muscular-type acetylcholine receptor, is (are) located in a volume located between 11.5 and 15.5 A from the alpha-carbons at positions 10 and 33 of the toxin, under the tip of the toxin first loop and close to the second one.

Acetylcholine↗