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Biomedical subjects

W Klein

Publications and source records attributed to W Klein.

At least 559 records · Page 31Linked to original sources
PubMedDate not supplied

Factors associated with emergency department utilization for nonurgent pediatric problems.

OBJECTIVE: To identify specific caretaker and utilization characteristics predictive of the use of the emergency departments (EDs) for nonurgent reasons. Each year more than 20 million children in the United States seek medical care in EDs. Between one third and one half of these visits are for nonurgent reasons. DESIGN: A descriptive study conducted during a 6-month period. SETTING: Two urban hospital EDs. MEASURE: A questionnaire was designed to elicit information about specific caretaker characteristics and their reasons for using the ED for their child's nonurgent medical care. SUBJECTS: Two hundred caretakers and children brought to the ED for nonacute medical care. Caretakers in this study included mothers (82%) with a mean age of 30 years, single caretakers (70%), and unemployed caretakers (60%). The average age of the children was 6.2 years. RESULTS: Most caretakers (92%) reported having a continuity physician for their children. Caretakers who reported being taken to the ED when they were children (P<.002) and those with Medicaid insurance (P<.001) were more likely to view the ED as the usual site of care. Being a single parent was a predictor for nonurgent visits (P<.05). CONCLUSIONS: Predicting which caretakers are at risk for using the ED for nonurgent care when their children are sick provides the primary care physician a means of identifying specific patients who may benefit from interventions designed to promote a more cost-effective approach to using medical resources. Arch Fam Med. 2000;9:1086-1092

Child↗
PubMedDate not supplied

Hemodynamic assessment of prenalterol: a cardioselective beta agonist in patients with imparied left ventricular function.

The hemodynamic effects of a new cardioselective beta agonist, prenalterol, were evaluated in 12 patients with moderate or severe impairment of left ventricular function due to coronary heart disease or primary cardiomyopathy. In doses up to 7 mg the drug led to a substantial increase of left ventricular pressure rise (+55%) and mean circumferential fiber shortening (+59%) and a decrease of left ventricular end-diastolic pressure (-52%), mean pulmonary artery pressure (-24%) and pulmonary vascular resistance (-37%) indicating augmented myocardial contractility and reduced left ventricular preload. Cardiac output was increased only in 4 of 12 patients, heart rate, left ventricular systolic and mean right atrial pressures and the pressure-rate product as an index for myocardial oxygen demand remained essentially unchanged. The same is true for stroke index, stroke work index, total peripheral resistance, left ventricular end-diastolic and end-systolic volume and ejection fraction. The positive inotropic effect was achieved with good tolerance and without arrhythmogenic or other side effects. Prenalterol may be especially useful in patients with low sympathetic activity and hypotension. In patients with diffuse congestive cardiomyopathy, high sympathetic activity, pronounced peripheral vasoconstriction and normal blood pressure, vasodilator therapy alone or in combination with prenalterol should be considered.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Detection of polycyclic aromatic hydrocarbon exposure damage using different methods in laboratory animals.

Benzo[a]pyrene, benzo[b]fluoroanthene and dibenzo[a,h]anthracene dissolved in a 1:2 mixture of dimethylsulphoxide (DMSO) and water were administered to two groups of female mice, each group containing 15 mice. The doses were administered orally (via gavage) at the respective rates of 1 and 100 micrograms kg-1 body weight five times per week for a period of 9 weeks. The influence of the polycyclic aromatic hydrocarbons (PAHs) was determined using the following methods: determination of DNA-PAH adducts, of chromosome injuries (micronucleus test), of induction of repair using the unscheduled DNA synthesis (UDS) test, and by examination of the DNA structure after nucleoid sedimentation. All the methods investigated provided evidence of a significant effect resulting from exposure to PAHs on the parameters examined. Following chronic exposure to PAHs, the formation of DNA-PAH adducts and injury to the genetic material, as well as the appearance of micronuclei (micronucleus test), the induction of unscheduled DNA synthesis (UDS test) and mutation of the DNA structure (nucleoid sedimentation), were demonstrated. The described methods therefore provide a means for the detection of genetic damage caused by PAH exposure in humans.

Administration, Oral↗
PubMedDate not supplied

[Arthroscopic surgical synovectomy of the knee joint (indications, technic, follow-up results)].

Between 1981 and 1986, synovectomy was performed arthroscopically at Düsseldorf University Orthopedic Clinic on 59 knee joints of 56 patients without opening the joint. Of these, 43 patients, i.e., 45 knee joints, were followed up on average 2.7 years postoperatively. In the author's experience arthroscopic-surgical synovectomy puts less strain on the patient. The risk of damaging cutaneous nerve branches is low, neuromuscular joint control is preserved, and no fibroarthrosis occurs. All the compartments of the knee joint - including, in particular, the posterior ones - are accessible from a few stab incisions. Since traumatization is minimal there is less postoperative pain than with the conventional method so that as a rule rehabilitation presents no problems, especially in the first six postoperative weeks. The indication threshold for arthroscopic synovectomy is lower than for conventional synovectomy, thus facilitating the decision to perform synovectomy early. In the event of recurrence the pathologic synovialis can once again be excised from the same approaches.

Adolescent↗
PubMedDate not supplied

[Meniscectomy--total, partial, open or closed operation?].

The importance of the menisci for stability of the knee joint is pointed out. Because of its mechanical importance in the knee a more conservative behaviour for treatment is recommended. Even the degenerated meniscus can play his role sufficiently. For each type of lesion individual surgery is applied, especially if there is locking impingement linked with mechanically induced arthritis. Out of the clinical results follows that arthroscopic partial meniscectomy is superior to conventional open meniscectomy, especially in the early postoperative period.

Follow-Up Studies↗