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  • 1
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Kardiopulmonale Reanimation: Defibrillation – Halbautomatische Defibrillatoren –Überlebensrate – Neurologische Langzeitprognose – Rettungssystem: Behandlungsqualität – Logistische Strukturen ; Key words: Cardiopulmonary resuscitation: defibrillation – Semi-automatic defibrillators – Survival – Neurology – Emergency medical services systems: quality – Logistic structures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. In a controlled prospective randomized study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany (basic life support by EMTs and defibrillation by emergency physicians only) in order to answer the following questions: 1. Does EMT defibrillation improve the survival rate and long-term prognosis of patients in ventricular fibrillation as compared to the current German standards in resuscitation (basic life support by EMTs and defibrillation by emergency physicians)? 2. Are the prerequisites for the use of semiautomatic defibrillators fulfilled in the emergency medical systems (EMS) of the participating centers? Methods. The study phase includes randomization of 121 adult patients with witnessed cardiac arrest and ventricular fibrillation (VF) as first ECG rhythm. Prior to the onset of the study, all EMTs of the participating EMS systems were retrained in basic life support (BLS) measures. In each center, randomly assessed EMT-Ds (EMTs trained in Defibrillation) were trained to use semiautomatic defibrillators. With the help of one-line tape recording, the time intervals during resuscitation and treatment steps were evaluated. Successfully resuscitated patients were followed up with the help of the Glascow Coma Scale and the Pittsburgh Cerebral and Overall Performance Categories. Results. From 1 February 1991 until 28 June 1992, 159 patients with VF were randomized. In 121 cases, collapse was witnessed. 25% (14/57) of the patients receiving defibrillation by EMT-Ds (study group=S) were discharged from the hospital alive. In the control group, 52 patients were defibrillated by emergency physicians, following BLS by EMTs [control group 1=C1; discharged: 29% (15/52)]. Fifty patients received BLS and advanced cardiac life support (ACLS) by the emergency physicians crews [control group 2=C2; discharged 18% (9/50)]. In the study group, the median time interval from collapse of the patient until initiation of BLS measures was 7.7 min, 7 min in C1 and 8 min in C2. ACLS measures were initiated significantly earlier (P〈0.05) in the control groups, as compared to the study group [S: 13 min, C1: 11 min; C2: 10.3 min]. Sixty-seven percent (30/45) of the study patients and 46% (36/76) of the control patients were defibrillated within 12 min. Study patients were defibrillated earlier (P〈0.05) (S: 9.9 min; C1: 12.2 min; C2: 12.75 min); return of spontaneous circulation (ROSC) was achieved earlier (P〈0.05) in the study group [S: 14 min; C1: 19 min; C2: 18.2 min] and the number of patients in the study group requiring no epinephrine during resuscitation was higher (P〈0.01) than in the control groups [S: 35.3% (12/34); C1: 10% (4/40); C2: 10.5% (4/38)]. Furthermore, the total amount of epinephrine [mean (±standard error)] administered in the study group [S: 2.35 (±0.49) mg; C1: 6.71 (±0.98) mg; C2: 7.71 (±1.31) mg] was significantly lower (P〈0.05). No significant differences in neurological long-term prognosis were found for the groups investigated. Conclusion. Neither the initial survival rate the number of patients discharged alive, nor the neurological long-term prognosis was significantly different for any of the groups investigated. Because of apparent differences in indirect prognostic parameters (time interval until ROSC, number of patients requiring no epinephrine) and because of the fact that the time interval to the first defibrillation was reduced by EMT defibrillation, EMT-Ds may perform defibrillation if: (a) they reach the patient before the emergency physician and (b) if they are trained intensively and supervised continuously. In order to increase the efficiency of defibrillation by EMT-Ds, far-reaching changes in our EMS are mandatory: (a) a reduction in the time interval from collapse until initiation of BCLS measures by intensifying layperson CPR training; (b) an increase in the number of emergency units equipped with semiautomatic defibrillators; (c) the consistent implementation of a tiered EMS.
    Notes: Zusammenfassung. In einer prospektiven Multicenterstudie wurde der Einfluß der Defibrillation durch Rettungsassistenten im Vergleich zum bisher praktizierten Verfahren (Basismaßnahmen der kardiopulmonalen Reanimation durch Rettungsassistenten und Defibrillation ausschließlich durch den Notarzt) auf die Überlebensrate und die neurologische Langzeitprognose bei 159 Patienten mit außerklinisch aufgetretenem Kammerflimmern untersucht. Alle Zeitintervalle des Reanimationsablaufs und die Behandlungsqualität wurden mittels Diktaphon erfaßt und nachvollzogen. Es bestanden keine signifikanten Unterschiede in der primären Überlebensrate, der Entlassungsrate und der neurologischen Langzeitprognose zwischen den untersuchten Gruppen. Aufgrund deutlicher Unterschiede zugunsten der Studiengruppe (Defibrillation durch Rettungsassistenten) in indirekten Parametern (kürzerer Zeitraum bis zur Wiederherstellung spontaner Kreislaufverhältnisse und größere Anzahl an Patienten, die kein Adrenalin benötigten) und der Tatsache, daß in den untersuchten Zentren der Zeitpunkt bis zur ersten Defibrillation signifikant nach vorne verlagert werden konnte, empfehlen wir die Defibrillation durch Rettungsassistenten: a) wenn sie den Patienten vor dem Notarzt erreichen, b) nach straffem Ausbildungsprogramm und unter kontinuierlicher ärztlicher Kontrolle. Um die Defibrillationsmaßnahme durch Rettungsassistenten effektiver werden zu lassen, müssen tiefgreifende Veränderungen im Rettungssystem vorausgehen: Verkürzung des Zeitintervalls bis zum Beginn von Basismaßnahmen sowie konsequente Durchführung eines gestaffelten Rettungssystems.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Der Anaesthesist 47 (1998), S. 320-329 
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Kardiopulmonale Reanimation ; Kammerflimmern ; Defibrillation ; automatisierter Defibrillator ; Impedanz ; biphasische Stromkurven ; Powerspektrumanalyse ; mediane Frequenz ; Frühdefibrillation ; Public Access ; Defibrillation ; Key words Cardiopulmonary resuscitation ; Ventricular fibrillation ; Defibrillation ; Automatic defibrillator ; Impedance ; Biphasic waveform ; Power spectrum analysis ; Median frequency ; Early defibrillation ; Public access defibrillation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Early defibrillation is the standard of care for patients with ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Technical developments aim at further miniaturization and simplification of defibrillators as well as adaptation of energy requirements to the patient´s needs. Implantable Cardioverter-Defibrillators (ICD) and automated external defibrillators (AED) are based upon the same technology. Both devices analyze the ECG signal internally, followed by a ”shock” or ”no shock” decision. Use of automated devices is the prerequisite for defibrillation by non-physicians. Chest impedance measurements and use of alternative shock waveforms, such as biphasic, aim at adaptation of energy or current to the patient’s individual needs and avoid application of unnecessarily high amounts of energy to the myocardium. Calculation of median frequency is a non-invasive method for analyzing the heart´s metabolic and electrical state. It helps to determine the optimal moment for defibrillation during cardiopulmonary resuscitation (CPR). Developments concerning the structure of in-hospital emergency systems or pre-hospital emergency medical services (EMS) aim at further reductions in time from collapse of a patient until first defibrillation. Such developments include early defibrillation programs for emergency medical technicians (EMT), nurses, and fire or police department first responders as well as wide distribution of easy-to-operate defibrillators in public areas, as discussed during the American Heart Association’s Public Access Defibrillation conferences. All programs of that kind have to be organized and supervised by a physician who is responsible for training and supervision of the personnel involved.
    Notes: Zusammenfassung In allen internationalen Empfehlungen stellt die schnellstmögliche Defibrillation die Maßnahme der Wahl bei Kammerflimmern (VF) und pulsloser ventrikulärer Tachykardie (VT) dar. Der Defibrillation kommt eine Schlüsselrolle bei der Bekämpfung des plötzlichen Herztodes zu. Technische Neuerungen: Entwicklungen auf technischem Gebiet haben einerseits eine weitere Miniaturisierung und Vereinfachung der Geräte, andererseits eine Anpassung der Energiemenge an die individuellen Patientenbedingungen zum Ziel. Implantierbare Kardioverter-Defibrillatoren (ICD) und automatisierte externe Defibrillatoren (AED) basieren auf der gleichen Technologie, einer geräteinternen Analyse des EKG-Signals mit nachfolgender „Schock-” oder „Kein-Schock”-Entscheidung. Die Verwendung von AED stellt die Grundlage für die Defibrillation durch nicht-ärztliches Personal dar. Die automatische Messung der Thoraximpedanz soll die für die erfolgreiche Defibrillation erforderliche Energie den Bedürfnissen des Patienten anpassen und unnötig hohe Energiemengen vermeiden. In diese Richtung zielen auch alternative Stromkurvenformen, wie die biphasische, bei welcher der Stromfluß nach einem vorgegebenen Intervall die Polarität ändert. Die Bestimmung der medianen Frequenz des VF als nicht-invasives Verfahren zur Bestimmung des metabolischen und elektrischen Zustands des Myokards soll helfen, den optimalen Zeitpunkt für eine erfolgreiche Defibrillation im Verlauf der kardiopulmonalen Reanimation (CPR) festzulegen. Strukturänderungen: Strukturelle Reformen des präklinischen Rettungs- und des innerklinischen Notfallsystems sollen das Zeitintervall vom Kollaps des Patienten bis zur Abgabe der ersten Defibrillation verkürzen. Unter der Maßgabe, daßärztliche Hilfe nicht rechtzeitig zur Verfügung steht, stellt die Defibrillation mittels automatisierter Geräte durch speziell ausgebildetes nicht-ärztliches Personal eine sichere und effektive Methode dar. Sie erfolgt im Rahmen der Notkompetenz des Rettungsassistenten oder von prä- und innerklinischen Frühdefibrillationsprogrammen. In der Diskussion sind momentan sog. First-Responder-Projekte, bei denen z.B. Feuerwehrleute oder Polizei- und Sicherheitspersonal schon vor Eintreffen des Rettungsdienstes mit Hilfe einfacher AED Patienten mit VF defibrillieren. In den USA wird momentan die weite Verbreitung einfachster automatisierter Defibrillatoren, ähnlich Feuerlöschern in öffentlichen Gebäuden, diskutiert.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1440
    Keywords: Bacillary angiomatosis ; Rochalimaea ; Acquired immunodeficiency virus ; Human immunodeficiency virus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A 52-year old male homosexual patient with acquired immunodeficiency syndrome (AIDS) presented in our clinic with multiple nodular papules (more than 100) spread over the whole body which had developed within 3 months. Bacillary angiomatosis was suspected, which is a bacterial infectious disease recognized recently mainly in patients with AIDS. Histological and immunohistochemical examinations of extirpated skin lesions were in agreement with the diagnosis, and the detection of rod-shaped bacteria in the lesions by Warthin-Starry silver stain confirmed it. The patient was treated with 2 × 100 mg doxycycline per day. The fever disappeared, and the cutaneous lesions showed a slight tendency to improve. However, after 5 days of therapy the patient showed increasing weakness, with muscle and bone pain. The patient died 10 days after the doxycyline therapy had been started. The cutaneous lesions in bacillary angiomatosis may resemble Kaposi's sarcoma and may therefore be misdiagnosed. The disease may be fatal, but timely antibiotic treatment is usually effective; therefore the diagnosis of bacillary angiomatosis is important. Although many cases have been reported from the United States, only one case is known from Europe. Our finding of bacillary angiomatosis in a German AIDS patient supports the concept of a worldwide distribution of this bacterial agent.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1440
    Keywords: Intestinal lymphoma ; Human mucosal lymphocyte antigen 1 ; Intraepithelial T cell ; Small intestine ; Enteropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    The journal of membrane biology 160 (1997), S. 127-140 
    ISSN: 1432-1424
    Keywords: Key words:Xenopus oocytes — Calcium channel —β subunit —α2δ subunit — Inactivation — Neuronal cells
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology
    Notes: Abstract. The α1 subunit coding for the human brain type E calcium channel (Schneider et al., 1994) was expressed in Xenopus oocytes in the absence, and in combination with auxiliary α2δ and β subunits. α1E channels directed with the expression of Ba2+ whole-cell currents that completely inactivated after a 2-sec membrane pulse. Coexpression of α1E with α2bδ shifted the peak current by +10 mV but had no significant effect on whole-cell current inactivation. Coexpression of α1E with β2a shifted the peak current relationship by −10 mV, and strongly reduced Ba2+ current inactivation. This slower rate of inactivation explains that a sizable fraction (40 ± 10%, n= 8) of the Ba2+ current failed to inactivate completely after a 5-sec prepulse. Coinjection with both the cardiac/brain β2a and the neuronal α2bδ subunits increased by ≈10-fold whole-cell Ba2+ currents although coinjection with either β2a or α2bδ alone failed to significantly increase α1E peak currents. Coexpression with β2a and α2bδ yielded Ba2+ currents with inactivation kinetics similar to the β2a induced currents, indicating that the neuronal α2bδ subunit has little effect on α1E inactivation kinetics. The subunit specificity of the changes in current properties were analyzed for all four β subunit genes. The slower inactivation was unique to α1E/β2a currents. Coexpression with β1a, β1b, β3, and β4, yielded faster-inactivating Ba2+ currents than currents recorded from the α1E subunit alone. Furthermore, α1E/α2bδ/β1a; α1E/α2bδ/β1b; α1E/α2bδ/β3; α1E/α2bδ/β4 channels elicited whole-cell currents with steady-state inactivation curves shifted in the hyperpolarized direction. The β subunit-induced changes in the properties of α1E channel were comparable to modulation effects reported for α1C and α1A channels with β3≈β1b 〉 β1a≈β4≫β2a inducing fastest to slowest rate of whole-cell inactivation.
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    European journal of orthopaedic surgery & traumatology 10 (2000), S. 265-268 
    ISSN: 1432-1068
    Keywords: Complex regional pain syndrome ; Shoulder ; Scoliosis ; Muscle dystrophy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this case report, the progression of the disease in a 14-years-old girl is described. Based on a minor cervical hyperextension and -flexion traumatization experienced during a basketball game she developed the symptoms of a non-reducible anterior shoulder instability and a subsequent thoracic scoliosis. Other symptoms resembled the clinical picture of a complex regional pain syndrome. Conservative and stabilizing surgical interventions to the shoulder turned out to be obsolete. Hence, at the end of a series of various treatment procedures, arthrodetic surgery had to be performed to leave the young patient painfree, yet with a functional impairment.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    European journal of orthopaedic surgery & traumatology 7 (1997), S. 271-275 
    ISSN: 1432-1068
    Keywords: Arthroscopic lateral release ; Patellar compression syndrome ; Section arthroscopique de l'aileron rotulien ; Syndrome fémoro-patellaire
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Dans cet article nous présentons la technique, les résultats ainsi que les complications et les indications de la section de l'aileron rotulien externe et la capsulorhaphie interne, à partir des résultats obtenus par l'examen de 7o malades souffrant les uns d'une légère latéralisation rotulienne externe et d'une hyperpression fémoro-patellaire externe (42 malades), les autres d'une luxation recidivante de la rotule (28 malades). La moyenne d'âge était de 26.2 ans (entre 9 et 54 ans). Au moment de l'examen de contrôle (m=64 mois) les malades ont été soumis à un examen clinique et radiologique. Les résultats ont été évalués conformément au score de Crosby et de Insall. 77 % des patients traités par relâchement latéral externe étaient satisfaits du résultat de l'opération (score analogue visuel) et 68 % des patients traités par capsulorhaphie. Par contre seulement 45 % des malades souffrant d'une ar-throse fémoro-patellaire traités par relâchement latéral externe parlaient d'une nette amélioration. Le score dit de Crosby et Insall donnait des résultats très significatifs mais ne montrait aucune différence parmi les résultats obtenus dans ces trois groupes. 13 % des malades souffraient d'un glissement de la rotule anormal en mobilisation active. Le test de glissement passif de la rotule montrait une hyper-mobilité de la rotule vers le côté latéral dans 37 % des cas et vers le côté médial dans 8o % des cas. Les radiographies des deux genoux montraient un angle de sulcus accru de 143 %. Cependant, aucune progression de l'arthrose n'a pu être relevée dans les articulations fémoro-patellaires opérées. Une hémarthrose post-opératoire précoce, nécessitant une révision, a été constatée dans un grand nombre de cas. Intérêt clinique: Vu les résultats sur les malades ayant souffert d'un syndrome d'hyperpression rotulienne sans arthrose patello-fémorale et les malades souffrant d'une luxation ou subluxation récidivante de la rotule, ces patients sont de bons candidats pour une section endoscopique de l'aileron rotulien externe et éventuellement pour capsulorhaphie interne. Dans une population relativement jeune la section endoscopique de l'aileron externe est une technique chirur-gicale relativement simple qui peut néanmoins être suivie par une technique “ouverte” en cas de défaillance de la première procédure.
    Notes: Summary Based on the results of 70 patients with mild lateral tracking and lateral compression of the patella, intact (22 patients) or defective (20 patients) cartilage of the patellofemoral joint, and recurrent patellofemoral dislocation (28 patients) we present the technique, results, complications and indications for the lateral retinacular release and medial imbrication of the vastus medialis obliquus. The average age of the patients was 26.2 years (range 9–54). At time of follow-up (m = 64 months) the patients were examined clinically as well as radiologically. The results were evaluated according to a Crosby and Insall score. 77% of the patients with mild lateral tracking and lateral compression (lateral release) were satisfied with the operative result (visual analog scale), as well as 68% of the patients with recurrent patellofemoral dislocation (lateral release and medial imbrication). Only 45% of the patients with patellofemoral arthritis (lateral release) reported an improvement in their condition after this procedure. The Crosby and Insall score showed significant improvement but did not show any difference between the 3 groups. 13% of the patients showed an abnormal lateral tracking of the patella in active motion. The passive patellar glide test showed patellar hypermobility to the lateral side in 37% of the cases and to the medial side in 80%. X-rays of both knees showed a sulcus angle of 143°. No progression in osteoarthritis in the operated patellofemoral joint was found. Hemarthrosis complicated a high number of cases in the early postoperative period, and in 3 cases an open revision was necessary. Clinical relevance: According to our results patients with patellar compression syndrome without patellofemoral arthrosis and patients with recurrent dislocation or subluxation of the patella are good candidates for endoscopic lateral release and medial imbrication of the medial vastus obliquus. In a young population endoscopic lateral release is a relatively simple surgical procedure making an open technique in failed cases possible later on.
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    European journal of orthopaedic surgery & traumatology 8 (1998), S. 141-143 
    ISSN: 1432-1068
    Keywords: Osteochondral graft
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Major cartilaginous defects of the femoral condyles of the knee joint, caused by chondropathy and chondral trauma can be a precursor to osteoarthritis. Particularly in cases with large defects the therapy often remains unsuccessful. Even the substitution of articular hyaline cartilage by autogenous osteochondral grafts, regarded as superior to other procedures like Pridies's drilling and abrasion arthroplasty, carries the risk of failure by necrosis of the craft and morbidity at the donor side. We present a 10-year follow-up case who had a large autogenous osteochondral graft from the non-weight bearing periphery of the patellofemoral joint that was implanted after necrosis of the medial femoral condyle following immunsuppressive chemotherapy.
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  • 9
    ISSN: 1432-1076
    Keywords: Key words: Hereditary metabolic disorders – Selective screening – Collaborative study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Since the early 1970s selective screening for inherited metabolic disorders has been performed in larger childrens hospitals or metabolic centres of the former East-Germany. As a rule the following methods were employed: initially paper chromatography, drop, dip and spot tests, later on thin-layer chromatography and more recently enzyme analysis, gas chromatography, mass spectrometry and HPLC. Normally urine, blood or leucocytes were investigated. The diagnoses were confirmed in metabolic centres in Greifswald, Berlin or Leipzig or in collaboration with specialized laboratories abroad. About 130 000 subjects from former East Germany as well as from different East European countries were investigated, of which 365 patients were diagnosed and classified into roughly 40 various metabolic diseases. The proportion of positive diagnoses was 1 in 400.
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    European journal of orthopaedic surgery & traumatology 8 (1998), S. 61-64 
    ISSN: 1432-1068
    Keywords: ACL rupture ; Arthrotomy ; Meniscectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A group of 94 male and 12 female patients who all suffered from ACL ruptures had a follow-up examination after a period of 14 to 21 years (m = 17.2 years). Each of them had undergone a primary arthrotomy with total or partial meniscectomy. In none of the cases, however, had operative repair of the ACL rupture been performed. The most frequent concomitant injury was a torn medial meniscus which occurred in 74.5% of the cases whereas a damaged lateral meniscus was found in 17.0% of the cases only. Chondromalacia of tibia, femur or patella was observed in 42.5% of the cases. Over 60% of the patients resumed their former sports activities, although in nearly 30% of these cases at a lower level whereas one third of the patients had to practice some other sport or were even forced to give up sports completely. 61.3% still complained about instability of the knee joint, 73.6% of the patients with partial or total meniscectomy had developed osteoarthritis of grade III and IV.
    Type of Medium: Electronic Resource
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