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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 42 (1999), S. 187-195 
    ISSN: 1437-1588
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The term „Ecstasy” includes a group of different methylenedioxyamphetamines which produce hallucinogenic activity, stimulation and the so-called ëentactogenic’ effects. –„Entactogen” is usually translated as „producing a touching within” or „creating an internal contact” and refers to the special psychotropic effect of this substances. Entactogens have been reported to make users aware of previously unconscious feelings and experiences. The „entactogenic” effect is the most typical of the psychedelic effects n 3,4-methylenedioxyamphetamine (MDMA). MDMA induces euphoria and acts stimulating, but the most common effect of MDMA is a heightened sense of „closeness” with other people. The negative effects, especially depression and a general sense of anxiety, may endure after the acute phase of ecstasy. Ecstasy is not a novel substance. However, the rapid spread connected with the arising techno-scene and the increasing prevalence of ecstasy-use world-wide is unprecedented. Epidemiological research of the last two years provides insights going further than just showing increasing numbers in the criminal statistics (e.g. ecstasy seizures; number of ecstasy users who became conspicuous the first time). According to surveys the lifetime prevalence of ecstasy is highest in the context of the techno culture, where ecstasy is mainly taken as a recreational drug. However, there seems to be a consumer group who exhibit extreme patterns of use and a high degree of psychic dependency. These consumers may be jeopardised by medical and psychiatric complications. The complications are due to the central and peripheral serotonergic effects of ecstasy. There are also neurotoxic side effects of ecstasy clearly proven in animal models and recently, for the first time, also shown in humans. The rate of psychic dependency is surprisingly high. Possible neurotoxic effects may be irreversible. In the face of the risks and the rapid spread of ecstasy suitable primary and secondary prevention is needed. Until now this has not been accomplished by the established structures.
    Notes: Zusammenfassung Ecstasy ist ein Sammelbegriff für verschiedene Methylendioxyamphetamine mit antriebssteigernder und halluzinogener Wirkung, die darüber hinaus eine sogenannte „entaktogene” Wirkung aufweisen. Der Begriff „entaktogen” wird als „im Inneren ein Gefühl erzeugen” oder „Herstellen einer inneren Berührung”übersetzt und charakterisiert die Wirkung psychoaktiver Stoffe, die unbewußte Gefühle und Erfahrungen wieder zugänglich machen und die Selbstreflexion fördern. Bei 3,4 Methylendioxymethamphetamin (MDMA) als Hauptvertreter dieser Gruppe steht diese entaktogene Wirkung im Vordergrund des erstrebten Rausches. Darüber hinaus erzeugt MDMA neben den auch vorhandenen antriebssteigernden und euphorisierenden Wirkungen ein Gefühl der großen Nähe zu anderen Menschen. Negative psychotrope Wirkungen können den akuten Rausch überdauern und werden vor allem in Form von depressiver Verstimmung und Angst erlebt. Ecstasy ist keine neue Substanz. Neu ist jedoch das Ausmaß und die Geschwindigkeit, mit der sich Ecstasy – gekoppelt an die Verbreitung der Techno-Party-Szene – weltweit durchgesetzt hat. Epidemiologische Untersuchungen der letzten zwei Jahre vermitteln Einblicke, die über die eindrücklichen Steigerungsraten der Bundeskriminalstatistiken (Sicherstellungsmengen; Anteil an den erstauffälligen Konsumenten) hinausgehen. Die aus Repräsentativerhebungen und Erhebungen in der Technoszene ermittelte Lebenszeitprävalenz für Ecstasy bestätigen den intensiven Gebrauch vor allem in dieser Szene als sog. „Freizeitdroge”. Darüber hinaus zeichnet sich jedoch die Existenz einer Konsumentengruppe mit exzessiven Gebrauchsmustern und psychischer Abhängigkeit ab. Für diese Gruppe wird ein erhebliches Risiko hinsichtlich medizinischer oder psychiatrischer Komplikationen angenommen. Diese Komplikationen lassen sich auf zentrale und periphere serotonerge Wirkungen von Ecstasy zurückführen bzw. durch die neurotoxischen Wirkungen von Ecstasy erklären. Die Quote psychisch abhängiger Ecstasy-Konsumenten ist überraschend hoch. Die möglichen neurotoxischen Wirkungen sind eventuell irreversibel. Die Risiken und die Ausbreitungsgeschwindigkeit von Ecstasy zeigen die Notwendigkeit geeigneter primär- und sekundärpräventiver Maßnahmen, die durch das herkömmliche Drogenhelfersystem bislang nur unzureichend geleistet werden konnten.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Emergency radiology 6 (1999), S. 259-261 
    ISSN: 1438-1435
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Emergency radiology 6 (1999), S. 279-281 
    ISSN: 1438-1435
    Keywords: Key words Face-to-face consultation – Radiology – Emergency medicine – Radiologic diagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To assess the impact of face-to-face exchange of clinical information between the radiologist and the emergency physician, a study was made of all plain films and computed tomograms (CTs) ordered in the Ohio State University Emergency Department between 11 am and 11 pm over a 4-week period. For each case, interpretations at three different times were recorded: (1) initial interpretation upon reception of the images, (2) interpretation after face-to-face discussion of clinical information with the emergency resident or attending physician, and (3) final interpretation after conferring with the attending radiologist. If any of the three interpretations differed in a given case, the case was flagged for review by a third attending radiologist to determine the clinical significance of the discrepancy. Cases which deviated from the standard model as described were excluded from the study. In total, 519 cases were ordered during the study period. Of which 231 (44.5 %) occurred in the standard order as described in the Methods section. Of these 231 cases, changes in diagnosis were observed in 31 (13 %) cases. In 12 (5.2 %) cases, the changes were judged to be clinically significant. In 19 (6 %) cases, the changes were judged to be clinically insignificant. The remaining 288 (55.5 %) cases diverged from the standard model described in our Methods section and were not included in our study. Of these, 93/519 (18 %) cases had only one interpretation because the resident radiologist, the emergency physician (resident and/or attending), and the attending radiologist were present for a single, simultaneous discussion. 77 (15 %) cases, there were only two interpretations because the initial interpretation occurred in the presence of both the resident radiologist and the emergency physician. In 69 (13 %) cases, there were two interpretations because the initial interpretation occurred in the presence of both the resident radiologist and the emergency physician. In 49 (9 %) cases, no face-to-face exchange between the resident radiologist and the emergency physician was recorded. Our data suggest that teleradiology's lack of face-to-face communication between the radiologist and the emergency physician may have an impact on the radiologic diagnosis, but only infrequently. Information contained in the images and the limited clinical history on the consult sheet appear to be sufficient for most purposes of radiologic interpretation.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    s.l. ; Stafa-Zurich, Switzerland
    Materials science forum Vol. 308-311 (May 1999), p. 211-218 
    ISSN: 1662-9752
    Source: Scientific.Net: Materials Science & Technology / Trans Tech Publications Archiv 1984-2008
    Topics: Mechanical Engineering, Materials Science, Production Engineering, Mining and Metallurgy, Traffic Engineering, Precision Mechanics
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Gliedergürteldystrophie ; Dystrophin ; Sarkoglykan ; Adhalin ; Emery-Dreifuss-Dystrophie ; Emerin ; Merosin ; Calpain-3 ; Muskeldystrophie Duchenne ; Muskeldystrophie Becker ; Key words Limb-girdle dystrophy ; Dystrophin ; Sarcoglycan ; Adhalin ; Emery-Dreifuss muscular dystrophy ; Emerin ; Merosin ; Calpain-3 ; Becker muscular dystrophy ; Duchenne muscular dystrophy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Recent progress in the field of molecular genetics revealed a broader spectrum of dystrophin-related disorders than previously assumed. In addition, the pathogenetic basis of other types of muscular dystrophies could be identified: some autosomal-recessive limb girdle dystrophies are caused by mutations of sarcoglycan genes, others are caused by deficiency of the sarcoplasmatic enzyme calpain-3. Emery-Dreifuss muscular dystrophy is due to the deficiency of the nuclear membrane protein emerin. About 50% of congenital muscular dystrophies are related to mutations of a extracellular matrix protein merosin (α-laminin). A series of monoclonal antibodies for immunohistochemistry is now available recognizing many cytoskeletal muscle proteins. In combination with molecular genetics a diagnostic flow chart can be developed which allows a definite diagnosis in most cases. In this review disease entities are illustrated by case reports. We discuss the significance of immunohistochemical and molecular methods for diagnosis.
    Notes: Zusammenfassung Neue Ergebnisse der molekularen Genetik haben in den vergangenen Jahren zu der Einsicht geführt, daß das klinische Spektrum der Erkrankungen, die auf Defekte des Muskelmembranproteins Dystrophin zurückgeführt werden können, erheblich breiter ist, als bisher angenommen wurde. Außerdem konnten die molekularen Ursachen anderer Unterformen der progressiven Muskeldystrophien identifiziert werden: ein Teil der autosomal-rezessiv vererbten Muskeldystrophien vom Gliedergürteltyp beruht auf Mutationen der Sarkoglykangene, andere auf Defekten der sarkoplasmatischen Protease Calpain-3; als Ursache der Emery-Dreifuss-Muskeldystrophie konnte ein Membran-Protein der Kernhülle identifiziert werden; etwa die Hälfte der kongenitalen Muskeldystrophien beruht auf Störungen des Merosins (=α2-Laminin), einer Komponente der extrazellulären Matrix. Es steht heute ein Repertoire an spezifischen Antikörpern gegen fast alle der o.g. Muskelproteine für die Immunhistologie zur Verfügung. Zusammen mit den Methoden der molekularen Genetik kann somit ein differenziertes diagnostisches Schema entwickelt werden, das in vielen Fällen zu einer definitiven Diagnose führt. Anhand eigener Fallberichte werden diese Krankheitsentitäten referiert und auf die differentialdiagnostische Bedeutung einer erweiterten immunhistochemischen und molekularen Diagnostik eingegangen.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1433-0385
    Keywords: Key words: Basal cell carcinoma ; Greater omentum ; Defect reconstruction. ; Schlüsselwörter: Basalzellcarcinom ; Omentum majus ; Defektdeckung.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Gelegentlich stellen Patienten mit jahrelang unbehandelten, zwischenzeitlich exulcerierten Malignomen an Brust, Thoraxwand und/oder Bauchdecke den plastischen Chirurgen vor die Notwendigkeit großer Defektdeckungen nach erfolgter Tumorresektion. Obwohl inzwischen zahlreiche gestielte oder freie mikrovasculäre myocutane Lappenplastiken zur Verfügung stehen, gibt es doch selten Tumorausdehnungen, bei denen diese Rekonstruktionsverfahren ungeeignet erscheinen. In diesen Fällen kann die gestielte Omentum-majus-Plastik zu einer geeigneten Alternative werden. Da eine sekundäre Deckung mit Meshgraft notwendig wird, erlangen bactericide, granulationsfördernde Wundauflagen zur Wundkonditionierung zunehmend an Bedeutung. Durch die Verwendung von silberhaltigem Aktivkohlevlies (Actisorb 3®) in Kombination mit hydroaktiven Polymerauflagen (Allevyn®) ließ sich nach Flankenersatz durch eine Omentumplastik im Rahmen der Resektion eines ausgedehnten Basalioms eine Infektion vermeiden. Nach sekundärer Meshgraftdeckung führten Fibrosierung und Calcifizierung des Omentums auch ohne Verwendung von Kunststoffnetzen zu einer stabilen Rumpfwand.
    Notes: Summary. Patients suffering from long-untreated malignomas of the chest or abdominal wall may require plastic surgery due to extensive defects after tumor resection. Despite a variety of pedicled or free myocutaneous flaps, there are defects in which these reconstructional options may not be indicated. In these patients, the omental flaps are a valid alternative. Since a secondary split skin graft is mandatory with the omentum flap, antibacterial and granulation-enhancing xerodressings are required for wound bed conditioning. We report one patient in whom the omentum flap was used for coverage of an extensive defect after resection of a widespread basal cell carcinoma at the lateral thorax and abdominal wall. After wound conditioning with silver-impregnated activated charcoal xerodressing (Actisorb) in combination with a hydroactive polymer dressing (Allevyn), secondary skin grafting was performed. In this patient fibrosis and calcification of the omentum led to stable abdominal wall coverage even without the application of a synthetic mesh.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Population ecology 41 (1999), S. 93-106 
    ISSN: 1437-5613
    Keywords: Key words Apparent competition ; Trophic cascades ; Exploitation competition ; Trophic effects ; Behavior ; Natural enemies ; Food webs
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract Indirect interactions between populations of different species can be important in structuring natural communities. Indirect effects are either mediated by changes in population densities (trophic or density-mediated effects) or by changes in the behavior of species that are not trophically connected (behavioral or trait-mediated effects). We reviewed the literature on aphids and their parasitoids to explore the various possible indirect interactions that can occur in such communities. The review was motivated by our study of a particular aphid–parasitoid community in a natural (i.e., nonagricultural) habitat, and by the wealth of information that exists about aphid–parasitoid systems in agricultural settings. We focused our review on aphid–parasitoid interactions, but considered how these were influenced by the other aphid natural enemies and also by aphid mutualists and host plants. We conclude that indirect effects are likely to have a major effect in structuring aphid–parasitoid communities, and that the latter are a valuable model system for testing ideas about community interactions.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Gamma-Hydroxybuttersäure ; Alkoholentzugssyndrom ; Intensivstation ; Halluzinationen ; Hypernatriämie ; Metabolische Alkalose ; Key words Gamma-hydroxybutyrate ; Alcohol withdrawal syndrome ; Intensive care unit ; Hallucinations ; Hypernatraemia ; Metabolic alkalosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Seeing as gamma-hydroxybutyrate (GHB) and benzodiazepines interact with the GABA-transmitter system, we investigated whether GHB can replace the conventional therapy, which uses benzodiazepines in the treatment of alcohol withdrawal syndrome in ICU settings. Methods: 42 chronic alcoholics were included in this prospective and randomized study. Folllowing the development of alcohol withdrawal syndrome, the patients were randomly allocated to the GHB or to the flunitrazepam group. In addition to this, clonidine was administered in order to treat autonomic signs of withdrawal. In cases were hallucinations occurred, haloperidol was administered. Results: There was no significant difference in the efficacy of treatment used in the duration of mechanical ventilation and intensive care unit stay between groups. The patients in the GHB-group required significantly higher dosages of haloperidol and significantly lower dosages of clonidine. 14 out of 21 patients from the GHB-group developed hypernatriaemia and 15 out of 21 developed a metabolic alkalosis. Conclusions: Symptoms of the autonomic nervous system were more effectively prevented by GHB as evident in the lower dosage requirement of clonidine. However, GHB may not sufficiently block the hyperactivity of the dopaminergic system or may have an hallucinogenic effect itself. This may be evident from the higher dosages of haloperidol which were necessary. Due to the latter fact, the administration of GHB cannot be recommended in all patients suffering from AWS in ICU settings.
    Notes: Zusammenfassung Gamma-Hydroxybuttersäure (GHB) und Benzodiazepine interagieren beide mit dem gabaergen Transmittersystem. Vergleichend wurden sie zur intravenösen Therapie des Alkoholentzugssyndroms bei Patienten einer interdisziplinären operativen Intensivstation eingesetzt. Methodik: 42 alkoholabhängige Patienten, die ein Alkoholentzugssyndrom entwickelten, wurden randomisiert entweder mit GHB oder Flunitrazepam behandelt. Additiv erhielten sie symptomorientiert Clonidin oder Haloperidol. Ergebnis: Zwischen den Gruppen bestanden keine signifikanten Unterschiede in der Effektivität der Therapie und der Dauer der intensivstationären Behandlung. Die Patienten der GHB-Gruppe benötigten jedoch signifikant höhere Dosen von Haloperidol und signifikant niedrigere Dosen von Clonidin. Als Nebenwirkungen traten in der GHB-Gruppe signifikant häufiger eine Hypernatriämie (14 von 21 Patienten) bzw. eine metabolische Alkalose (15 von 21 Patienten) auf. Schlußfolgerungen: Die vegetative Symptomatik war mit GHB besser therapierbar als mit Benzodiazepinen. Als Erklärung für den erhöhten Haloperidolbedarf in der GHB-Gruppe ist eine unzureichende Blockierung des dopaminergen Systems und damit die unzureichende Dämpfung der produktiv-psychotischen Symptomatik sowie ein halluzinogener Effekt der Substanz selbst denkbar. Deshalb kann GHB nur zur Therapie des Alkoholentzugssyndroms mit vegetativer Symptomatik, jedoch nicht bei Halluzinationen empfohlen werden.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1432-1238
    Keywords: Key words Hypoxia ; Ischemia ; Acute phase proteins ; Cardiac arrest ; Infections
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Inflammation and hypoxia are frequently associated, but their interaction is poorly understood. In vitro studies have shown that hypoxia stimulates the genes of acute phase proteins (APP) and cytokines known to induce APP. We decided to determine kinetics and potential determinants of an acute phase response after cardiac arrest and to assess whether isolated moderate hypoxia can induce APP in humans in vivo. Design: Prospective, observational study in patients and human experiment. Setting: Tertiary care university hospital. Patients and participants: 22 patients after primarily successful cardiopulmonary resuscitation (CPR) and 7 healthy volunteers. Interventions: None in patients; exposure of volunteers to simulated altitude (460 torr/6 h). Results: Following CPR, type-1 APP (C-reactive protein, α1-acidglycoprotein, serum amyloid A) and type-2 APP (haptoglobin, α1-antitrypsin) increased consistently within 1–2 days and the ’negative' APP transferrin was downregulated. This APP response occurred irrespective of the cause of arrest, the estimated time of anoxia, clinical course or patient outcome and was not different in patients with and without infectious complications. Exposure of healthy volunteers to less severe but more prolonged hypoxia did not induce APP, although a time dependent increase of serum erythropoietin (EPO) was measurable under these conditions, indicating the activation of oxygen dependent gene expression. Conclusions: (i) A marked acute phase response occurs regularly after cardiac arrest, but within the complexity of this situation the severity of hypoxia is not a predominant determinant of this response. (ii) Despite in vitro evidence for similarities in the oxygen dependent regulation of APP and EPO production, the oxygen sensitivity of these proteins in vivo is different. (iii) Measurements of APP are not revealing regarding infectious complications in the early phase after CPR.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Oecologia 119 (1999), S. 120-125 
    ISSN: 1432-1939
    Keywords: Key words Establishment ; Aphids ; Predator community ; Mutualists ; Dynamic monophagy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract We investigated why two species of aphids (Aphis jacobaeae and Brachycaudus cardui) were very rare in a study site despite their abundance in the surrounding area. The study site contained many common species of aphid and we tested the hypothesis that the community of aphid predators in the field excluded the missing species. Colonies of the two aphid species were artificially initiated in the experimental site and allocated to one of four treatments: control; ground predator exclusion; total predator exclusion, and provision of mutualist ants. Two measures of colony performance were analysed: longevity and cumulative aphid density. Colonies decline naturally in late summer but control colonies disappeared very quickly while colonies protected from all predators survived the longest. The performance of colonies protected from just ground predators was intermediate. We failed to persuade ants to tend A. jacobaeae. Colonies of B. cardui attended by ants performed better than controls and those with ground predators excluded, but not as well as those with all predators excluded. We conclude that the absence of the two species of aphid in the study site is influenced by the resident predator community, and by the availability of mutualists.
    Type of Medium: Electronic Resource
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