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Biomedical subjects

P Rosenberger

Publications and source records attributed to P Rosenberger.

13 recordsLinked to original sources
PubMed2006

[Perioperative echocardiography: basic principles].

Over the past decades, echocardiography has undergone a continuous evolution in technology that has promoted its clinical application and acceptance throughout perioperative medicine. These technological advances include improvements in transducer development that permit superior imaging quality and a wider selection of probes for epicardial, epiaortic, and surface echocardiography which can also be used in conjunction with multiplane transesophageal echocardiography. Moreover, the addition of Doppler technology and digital acquisition has secured the role of echocardiography as a valuable and relatively noninvasive diagnostic tool for the assessment of cardiovascular disease and hemodynamic monitoring throughout the perioperative period. Therefore, it has become increasingly important for perioperative physicians to understand the basic principles and underlying fundamental concepts pertaining to the technology and physics of echocardiography, as well as its inherent limitations. The current review outlines the modes and applications of different echocardiographic techniques used in perioperative echocardiography including M-mode, two-dimensional echocardiography, and Doppler assessment of blood flow. In addition, the limitations of these techniques and typical artifacts associated with the perioperative use of echocardiography are described.

Artifacts↗
PubMed2005

[Preoperative evaluation and perioperative management of patients with increased cardiovascular risk].

Due to the increasing age in western countries, combined with high rates of major surgical interventions in high-risk patients, perioperative reduction of cardiovascular complications becomes increasingly more important for perioperative physicians. After identifying patients with increased perioperative risk, specific interventions need to be considered to reduce their risk for cardiovascular complications, either by perioperative medical therapy or specific treatment options (e.g. coronary intervention). Several trials have demonstrated an effect of perioperative beta-blocker-therapy in reducing cardiovascular complications among high-risk patients. Additionally, several monitoring techniques are effective in detecting cardiovascular complications. Nevertheless, it remains unclear whether they are associated with a measurable improvement of outcome. Based on the ACC/AHA-guidelines, the present review describes a stepwise approach to surgical patients to identify perioperative risks, based on specific patient related risk factors, the kind of surgery and on the specific setting (emergency versus elective surgery). In addition, strategies to reduce perioperative cardiovascular complications are discussed.

Cardiovascular Diseases↗
PubMed2003

[Epicardial echocardiography intraoperative diagnostic utility to assess valve function].

Epicardial echocardiography has been available since the early 1970s as an intraoperative diagnostic modality to assess ventricular and valvular function. With this technique, an ultrasonic transducer is placed directly on the epicardial surface of the heart, following sternotomy and pericardiotomy. Under the guidance of the cardiac anesthesiologist, the surgeon places the transducer so that the desired views of cardiac structures and great vessels can be obtained. The anesthesiologist performs the acquisition, analysis and interpretation of the echocardiographic images. Despite the feasibility of epicardial echocardiography, transesophageal echocardiography (TEE) has emerged over the last two decades as the main form of intraoperative echocardiography. Although TEE allows continuous monitoring of cardiac and valvular function without interruption of the surgical procedure, placement of a TEE probe may be difficult or contraindicated in some patients. In such cases, epicardial echocardiography may be the optimal ultrasonographic imaging modality to assess ventricular and valvular function during cardiac surgery. We describe the use of epicardial echocardiography for intraoperative assessment of valvular function in two patients where TEE was either contraindicated or probe placement could not be performed safely. The first patient underwent surgical repair of the mitral valve for severe mitral regurgitation. After weaning the patient from cardiopulmonary bypass (CPB), epicardial echocardiography was used to confirm successful reconstruction of the valve and to exclude residual mitral regurgitation. The second patient was scheduled for coronary artery bypass grafting (CABG). Prior to the initiation of CPB, the presence of moderate aortic stenosis was confirmed using Doppler echocardiography via an epicardial approach.

Aged↗
PubMed1999

Depletion of cutaneous peptidergic innervation in HIV-associated xerosis.

Severe xerosis occurs in approximately 20% of human immunodeficiency virus seropositive patients. Changes in cutaneous innervation have been found in various inflammatory skin diseases and in xerotic skin in familial amyloid. We have therefore carried out a quantitative examination of the cutaneous peptidergic innervation in human immunodeficiency virus-associated xerosis. Immunohistochemistry and image analysis quantitation were used to compare total cutaneous innervation (protein gene product 9.5), calcitonin gene-related peptide, substance P, and vasoactive intestinal peptide peptidergic fibers, at two sites in the skin of human immunodeficiency virus-associated xerosis patients (upper arm, n = 12; upper leg, n = 11) and site-matched seronegative controls (upper arm, n = 10; upper leg, n = 10). Measurement of lengths of fibers of each type was carried out for each subject in the epidermis and papillary dermis, and around the sweat glands. Immunostained mast cells in these areas were counted. Epidermal integrity and maturation were assessed by immunostaining for involucrin. There were significant (Mann-Whitney U test; p < 0.02) decreases in total lengths of protein gene product 9.5 fibers in both epidermis/papillary dermis and sweat gland fields; of calcitonin gene-related peptide innervation in the epidermis/papillary dermis; and of substance P innervation of the sweat glands. There were no differences in the distribution of mast cells, or in the epidermal expression of involucrin. Depletion of the calcitonin gene-related peptide innervation may affect the nutrient blood supply of the upper dermis, and the integrity and function of basal epidermis and Langerhans cells. Diminished substance P innervation of the sweat glands may affect their secretory activity. Both of these changes may be implicated in the development of xerosis.

Adult↗
PubMed1993

Neuropsychological performance in symptomatic and asymptomatic HIV infection.

OBJECTIVE: To examine cognitive function in patients at various stages of HIV infection, and to determine the nature and severity associated with stage of illness. DESIGN: Subjects were administered an extensive battery of neuropsychological tests. SUBJECTS: Two hundred and thirty-three HIV-1-infected homosexual/bisexual men and 77 HIV-negative control subjects who had been screened for previous neurological illness. All subjects were volunteers in a longitudinal study of neurobehavioral complications of HIV infection. RESULTS: Patients with symptomatic infection differed from controls on a large number of measures, and asymptomatic patients had a more circumscribed pattern of deficit. On a summary measure of cognitive impairment, there was a twofold increase in the prevalence of impairment in asymptomatic patients relative to controls, and a fourfold increase in symptomatic patients. Memory and dexterity problems appear to be early features of neurobehavioral dysfunction, and frontal lobe deficits were found in patients with symptomatic infection. CONCLUSION: These data indicate that there is a steady increase in the prevalence of neurobehavioral abnormalities associated with stage of infection. The pattern of abnormality also varies with disease stage.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Depression and neuropsychological performance in asymptomatic HIV infection.

OBJECTIVE: The authors examined the effect of depression on neuropsychological performance in HIV-infected men. Previous studies have suggested that depression may account for the neuropsychological abnormalities observed in some patients with HIV infection, but few studies have specifically examined this question. METHOD: An extensive neuropsychological test battery was administered to 121 HIV-seropositive asymptomatic men and 42 HIV-seronegative comparison subjects. The seropositive subjects were grouped into depressed and non-depressed groups on the basis of scores on the Beck Depression Inventory, Hamilton Rating Scale for Depression, and Structured Clinical Interview for DSM-III-R. RESULTS: Statistical comparisons revealed very few measures on which the depressed seropositive subjects scored significantly worse than either of the nondepressed comparison groups. The nondepressed seropositive group differed consistently from the seronegative comparison subjects on measures of verbal memory and dexterity. CONCLUSIONS: These data indicate that the subtle neuropsychological abnormalities observed in some asymptomatic HIV-seropositive subjects cannot be attributed to depression. These data also indicate the advantages of a multifaceted approach to assessment of depression.

Adult↗
PubMed1993

Drug and alcohol use and neuropsychological performance in asymptomatic HIV infection.

The effect of drug and alcohol abuse on neuropsychological performance was examined in 132 human immunodeficiency virus-seropositive gay or bisexual men. Syndromal (diagnostic) criteria of alcohol/drug abuse based on DSM-III-R were used, and quantitative estimates of alcohol consumption were obtained. Very few differences appeared between substance abuse subgroups formed on the basis of recency or severity of drug use. There were some correlations with the quantitative estimate of alcohol use, but not on the measures previously found to differentiate seronegative and asymptomatic seropositive gay men. These data indicate that alcohol use does affect neuropsychological performance but does not account for the differences observed in studies of seronegative and seropositive subjects.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Neuropsychological performance in asymptomatic HIV infection.

This study compared 74 human immunodeficiency virus (HIV)-negative and 131 HIV-positive asymptomatic homosexual or bisexual men on an extensive neuropsychological test battery. HIV-positive subjects' performance was significantly worse on verbal memory and psychomotor skills. The prevalence of mild but persistent neurobehavioral impairment in the HIV-positive group was approximately twice that in HIV-negative patients, consistently across several criteria for impairment. There was evidence that degree of neuropsychological impairment was related to patients' perceptions of dysfunction in daily life. Findings were not related to degree of depression or to medication effects. These data suggest that approximately 10% to 20% of HIV-positive asymptomatic men suffer mild neuropsychological impairment that influences their daily lives.

AIDS Dementia Complex↗
PubMed1989

Content bias of the MacAndrew's Alcoholism Scale in seizure disorder patients.

The possibility of content bias in the MacAndrew's Alcoholism Scale (MAC) from the MMPI was examined in groups of seizure disorder (n = 35), general medical (n = 25), and psychiatric patients (n = 20). Scores above criteria on the MAC were associated with reported alcohol problems only for the psychiatric patients. Almost 50% of the seizure patients with no such history had scores above criteria on the MAC. This classification inaccuracy is even greater than that reported recently in contemporary normal samples. The results suggest that caution should be used when one is administering the MAC to seizure disorder patients and that further investigation of possible content bias in other MMPI scales or subscales should be pursued.

Adult↗
PubMed1981

Comparison of opiate addicts' reports of psychiatric history with reports of significant-other informants.

This study compares self-reports by a sample of 50 opiate addicts with reports of 50 "significant other" informants, on past and current functioning. Moderate to high levels of agreement are found using the Intraclass Correlation Coefficient (ICC) in reporting current opiate use, current employment, and current legal pressures. This finding is consistent with previous studies which found good agreement between addicts and informants in these areas. However, much poorer agreement between addicts and informants is found in assessing the severity of addict's social, employment, and psychological problems, and in assessing the more detailed aspects of drug use. A comparison of the percent agreement data with ICC data used in this study provides empirical support for the argument that percent agreement data represents an inflated estimate of concordance between raters. These findings suggest that addicts and their families have rather divergent perceptions of the addict's problems and, in addition, indicate the value of including family members or significant others in the process of evaluating and treating opiate addicts. The results of the statistical analysis underscore the need in reliability studies of rigorous statistics that take into account chance agreement.

Adolescent↗