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Biomedical subjects

A Heinemann

Publications and source records attributed to A Heinemann.

At least 73 records · Page 4Linked to original sources
PubMed1995

HIV and suicide in Hamburg.

Established data relating to HIV infection, AIDS, drug user related deaths and suicides were evaluated at the Institute of Forensic Medicine in Hamburg in order to gain an insight into suicide and HIV. There was no evidence of an increased suicide ratio among HIV infected drug users. The drug aid system appears to be relatively well organized. In this group the risk of death is not dependent on HIV infection status or concomitant disease, but on overdosing. The need for detailed studies is obvious. There was no obvious increase in the suicide ratio among all HIV infected persons and AIDS cases. From the point of view of forensic medicine the number of completed suicides with HIV present was low (3 cases per year reported from the central morgue). The work of the support system in Hamburg seems to be successful, but there may be a relevant number of undetected cases. Up to now the data available about individual cases are inconclusive. An interdisciplinary European effort may be helpful in order to elucidate the problem from the point of view of different support and registration system for people with HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Mediation by CCKB receptors of the CCK-evoked hyperaemia in rat gastric mucosa.

1. Cholecystokinin octapeptide (CCK-8) and gastrin-17 augment gastric mucosal blood flow in the rat. The present study examined whether the gastric vasodilator effect of these peptides is mediated by CCKA or CCKB receptors. 2. Intravenous injection of CAM-1481 (1 mg kg-1), a dipeptoid antagonist of CCKA receptors, or CAM-1028, a dipeptoid CCKB receptor antagonist (1 mg kg-1), had no effect on basal gastric mucosal blood flow as determined by the clearance of hydrogen in urethane-anaesthetized rats. 3. Intravenous infusion of CCK-8 or gastrin-17 (8-200 pmol min-1) increased gastric mucosal blood flow in a dose-dependent fashion. The CCKB receptor antagonist, CAM-1028, significantly attenuated the hyperaemic response to CCK-8 and gastrin-17 whereas the CCKA receptor antagonist, CAM-1481, did not antagonize CCK-8 but caused a slight attenuation of the vasodilator response to gastrin-17. 4. The selectivity of the two antagonists was proved by the findings that CAM-1028, but not CAM-1481, inhibited gastric acid secretion evoked by CCK-8 or gastrin-17 (CCKB receptor assay) while CAM-1481, but not CAM-1028, inhibited the CCK-8-induced contraction of guinea-pig isolated gall bladder strips (CCKA receptor assay). 5. These data show that the actions of CCK-8 and gastrin-17 to increase mucosal blood flow in the rat stomach are primarily mediated by CCKB receptors.

Animals↗
PubMed1995

Diverse interactions of calcitonin gene related peptide and nitric oxide in the gastric and cutaneous microcirculation.

Calcitonin gene related peptide (CGRP) is the major mediator of afferent nerve mediated vasodilatation in the gastric mucosa and skin of the rat. Since receptors for CGRP occur on both the vascular endothelium and smooth muscle, it is conceivable that the vascular actions of CGRP involve multiple mechanisms. The vasodilator effect of rat CGRP-alpha in the rat gastric mucosa is indeed inhibited by blockage of nitric oxide (NO) synthesis, as is the gastric mucosal hyperemia in response to gastric acid challenge, which is mediated by CGRP release from afferent nerve fibres. In contrast, the vasodilator response to rat CGRP-alpha in the rat hind paw and the CGRP-mediated vasodilatation evoked by antidromic stimulation of afferent nerve fibres do not depend on the formation of NO. These data indicate that NO plays regionally different roles in the local vasodilator action of CGRP. NO is a secondary vasorelaxant messenger of CGRP in the gastric, but not in the cutaneous, microcirculation. However, this L-arginine-derived autacoid may have a role in the irritant-induced CGRP release from afferent vasodilator fibres in the skin.

Animals↗
PubMed1995

The national jockey injury study: an analysis of injuries to professional horse-racing jockeys.

While there have been numerous reports in the literature of accidents in equestrian sports, no comprehensive study has been conducted to ascertain the nature and incidence of injuries incurred by professional horse-racing jockeys. A survey was conducted to determine the types of injuries to jockeys and racing-related health concerns, including weight reduction methods. The questionnaire was completed by 706 professional jockeys actively competing at United States racetracks between July and October 1990 about injuries they had sustained in their careers. More than 1,700 injuries were reported. Fractures (n = 1,113) accounted for 64% of the total. The most common cause of injury was becoming unseated, followed by the horse falling. Relationships between characteristics of jockeys and injuries were evaluated. There were significant numbers of serious injuries with prolonged periods of not riding. Recommendations for improving jockey safety are made.

Absenteeism↗
PubMed1995

Influence of hydroxycarboxylic acids on the water solubility of various bismuth compounds.

In an equilibrium dialysis assay (bismuth being determined by atomic absorption spectrometry) a constant amount of bismuth (Bi, CAS 7440-69-9) (final maximum conc. 50 mumol Bi/l) was dialyzed against solutions with increasing concentrations of the chelators (0-25 mmol/l). At pH 5, 50% of Bi(III) nitrate was soluble in solutions with 0.3, 6.3, 13.4 and 14.6 mmol/l of edetic acid (EDTA), citric, tartaric and malic acid, respectively. At the highest concentration applied, lactic acid kept 7% of bismuth in solution. Without any chelator, bismuth was found to be essentially insoluble (limit of detection: approx. 4 nmol Bi/l). A concentration-dependent increase in solubility was found also for the other bismuth compounds; the sequence of the solubilizing capacity of the chelators was the same as for Bi(III) nitrate. Lowering the pH to 3 generally increased and raising the pH to 7, decreased the solubility of bismuth.

Bismuth↗
PubMed1994

Vascular bed-dependent roles of the peptide CGRP and nitric oxide in acid-evoked hyperaemia of the rat stomach.

1. Acid back-diffusion through a disrupted gastric mucosal barrier is known to increase gastric mucosal blood flow via a neural mechanism. The present study examined how the acid-evoked change in the gastric microcirculation compares with blood flow changes in the left gastric artery, one of the major arteries supplying the stomach, and whether the dilator mediators in the left gastric artery are identical to those in the gastric mucosa. 2. The experiments were performed on rats anaesthetized with urethane. Blood flow in the left gastric artery was measured by the ultrasonic transit time shift technique, and blood flow in the gastric mucosa was assessed by the hydrogen gas clearance method. 3. Gastric acid back-diffusion evoked by perfusion of the stomach with 15% ethanol in 0.15 M HCl increased blood flow in the left gastric artery by a factor of 4.7, which was significantly larger than the 2.9-fold increase in blood flow through the gastric mucosa. Blood pressure and heart rate were not altered appreciably. 4. The acid-evoked hyperaemia in the left gastric artery was left unaltered by atropine and the substance P receptor antagonist RP-67580. 5. The calcitonin gene-related peptide (CGRP) antagonist CGRP (8-37) had no effect on gastric blood flow but prevented the dilator action of CGRP and inhibited the acid-evoked hyperaemia in the gastric mucosa to a larger degree than the hyperaemia in the left gastric artery. 6. Blockade of nitric oxide synthesis by N omega-nitro-L-arginine methyl ester (L-NAME) caused constriction of the left gastric artery and the gastric mucosal microvessels. The acid-evoked vasodilatation in the gastric mucosa was blocked by L-NAME, whereas the dilator response in the left gastric artery was not significantly depressed. 7. The data show that the gastric hyperaemic response to acid back-diffusion results from dilatation of mucosal microvessels and extramural arteries. The dilator mechanisms, however, differ between the two vascular beds. CGRP and nitric oxide are important vasodilator mediators in the gastric mucosa but are of less relevance in the left gastric artery.

Animals↗
PubMed1994

Coping with traumatic brain injury: representative case studies.

This case report compares the use of social supports and vulnerability to substance abuse for two rehabilitation clients after traumatic brain injury (TBI). Using a psychosocial assessment, the Motivational Structure Questionnaire, Adaptive Skills Battery, and Ways of Coping Checklist within a representative case method, we studied two individuals in depth to understand differences in postinjury drinking behaviors. We also examined differences in availability and use of social supports and how support was related to coping efforts. Finally, we illustrated goal-setting and the relationship between long-term planning and follow-through on goals. Social supports, adaptive problem-solving behaviors, and positive reappraisal of situations seem to be important elements in postinjury abstinence. Clinically, this research supports the need for fostering use of both social supports and substance use prevention and treatment services when working with both inpatient and outpatient TBI clients.

Adaptation, Psychological↗
PubMed1993

Nitric oxide-dependent and -independent hyperaemia due to calcitonin gene-related peptide in the rat stomach.

1. Calcitonin gene-related peptide (CGRP) potently enhances mucosal blood flow in the rat stomach. The aim of this study was to examine whether CGRP also dilates extramural arteries supplying the stomach and whether the vasodilator action of CGRP involves nitric oxide (NO). 2. Rat CGRP-alpha (0.03-1 nmol kg-1, i.v.) produced a dose-dependent increase in blood flow through the left gastric artery (LGA) as determined by an ultrasonic transit time technique in urethane-anaesthetized rats. Blockade of NO synthesis by NG-nitro-L-arginine methyl ester (L-NAME, 20 and 60 mumol kg-1, i.v.) significantly reduced basal blood flow (BF) in the LGA and attenuated the hyperaemic activity of CGRP by a factor of 2.8-4. D-NAME tended to enhance basal BF in the LGA but had no influence on the dilator activity of CGRP. The ability of vasoactive intestinal polypeptide to increase left gastric arterial blood flow remained unaltered by L-NAME. 3. L-NAME (20 and 60 mumol kg-1, i.v.) evoked a prompt and sustained rise of mean arterial blood pressure (MAP) and caused a slight decrease in the hypotensive activity of CGRP. In contrast, D-NAME induced a delayed and moderate increase in MAP and did not influence the hypotensive activity of CGRP. 4. Rat CGRP-alpha dilated the isolated perfused bed of the rat LGA precontracted with methoxamine and was 3 times more potent in this respect than rat CGRP-beta. The dilator action of rat CGRP-alpha in this preparation was not affected by L-NAME or D-NAME (40 microM). 5. L-NAME (60 micromol kg-1, i.v.) reduced gastric mucosal blood flow as assessed by laser Doppler flowmetry and diminished the hyperaemic activity of rat CGRP-alpha in the gastric mucosa by a factor of 4.5, whereas D-NAME was without effect.6. These data show that CGRP is a potent dilator of mucosal and extramural resistance vessels in the rat stomach. Its dilator action involves both NO-dependent and NO-independent mechanisms.

Anesthesia↗
PubMed1990

Classification of pressure ulcers.

Several systems exist for classifying pressure ulcers, though none of them have been evaluated for interrater reliability. A new grading scale was compared with the commonly used Shea classification. This new scale was developed to provide a more complete description of pressure ulcer healing. The advantages of this scale include a classification of red areas as ulcers to help prevent further deterioration and classification of healed sores to note potential problems. The Yarkony-Kirk scale classifies a red area as a grade 1 ulcer, and involvement of the epidermis and dermis with no subcutaneous fat observed as a grade 2 ulcer. Grade 3 indicates exposed subcutaneous fat with no muscle observed. Exposed muscle without bone involvement is classified as a grade 4 ulcer, and grade 5 describes exposed bone with no joint space involvement. Grade 6 indicates joint space involvement. There is a classification of pressure sore healed to indicate a healed pressure ulcer. Interrater reliability was assessed by two nurses. In spite of an increased number of categories for the Yarkony-Kirk scale, there was no decline in reliability. Reliability was excellent with an interrater correlation of 0.90 for the Yarkony-Kirk scale and 0.86 for the Shea classification when measured for 72 patients. Eighty-five percent of the ratings for the Yarkony-Kirk scale were identical, whereas only 68% were identical for the Shea classification. Three percent of the ratings for the Shea classification were greater than +/- 1 category; 6% of the ratings for the Yarkony-Kirk scale were greater than +/- 1 category. This scale appears to possess good reliability and to describe pressure ulcers more completely. This scale may also be used to teach prevention activities as well as ulcer classification.

Humans↗
PubMed1990

Rehabilitation outcomes in patients with posttraumatic epilepsy.

This study investigated 238 consecutive admissions to an adult head trauma unit during six years. Eighty-seven patients with posttraumatic epilepsy (PTE) were identified. Rehabilitation outcome was measured by a locally developed rating scale obtained at admission and discharge for all head trauma patients. The PTE and non-PTE groups were comparable in terms of demographic and medical characteristics except for proportion of men, which was higher in the PTE group (84% vs 66%, p less than .05). Both groups demonstrated significant functional gains on all measures during the course of their hospitalization (p less than .01), although the PTE patients demonstrated lower levels of function at admission and discharge on items rated by physical, occupational, speech, and recreation therapists, and by psychologists. Furthermore, PTE patients required a higher level of nursing care on discharge (p less than .05). It appears that PTE does not impede the rehabilitation process but significantly impacts posthospital rehabilitation plans of patients with blunt head injuries.

Activities of Daily Living↗
PubMed1989

Risk factors for heterotopic ossification in spinal cord injury.

Heterotopic ossification (HO) is a complication in 16% to 53% of spinal cord injured (SCI) patients. One third of these patients have moderate to severe HO that adversely affects function or health. Pharmacologic prophylaxis of HO for all SCI patients continues to be controversial. High-risk criteria for HO formation identified in total hip replacement patients are not applicable to SCI. A review of the literature did not reveal specific risk factors for HO with SCI. The charts of 100 randomly selected SCI patients, 50 with HO and 50 without HO, were reviewed retrospectively to learn if criteria which would predict high-risk patients could be identified. A total of 14 variables, seven demographic (age, sex, race, level of lesion, completeness of lesion, cause of injury, and geographic locus of patient) and seven medical (bladder stones, fractures, pressure sores, deep vein thrombosis, pulmonary embolism, spasticity, and urinary tract infections) were studied. Four of the 14 variables (age, completeness of lesion, presence of pressure sores, and spasticity) were significantly related to HO formation. The risk factors appear to be additive. When all were present, 92% of patients were found to have HO. Before the findings are applied clinically, it is suggested that a prospective study be conducted to confirm the risk predictive value of these factors in HO.

Adult↗
PubMed1989

Recovery of function during inpatient rehabilitation for moderate traumatic brain injury.

This study evaluated the functional improvement of 189 patients with traumatic brain injury (TBI) who participated in a comprehensive rehabilitation program at a National Institute on Disability and Rehabilitation Research--designated Center for traumatic brain injury rehabilitation. Data were comprised of functional ratings reported by therapists in nine disciplines. Improvement in mobility, self-care, communicative, family, nursing, psychological, and recreation functions were observed. The relationship between functional level and length of stay, onset-admission interval, age, sex, education, and work history were examined. The benefits of rehabilitation are supported by this multidimensional study.

Adolescent↗
PubMed1988

Rehabilitation outcomes in complete C5 quadriplegia.

Establishment of rehabilitation goals for spinal cord injury patients generally has been based on the degree of residual motor function. Despite extensive clinical experience with spinal cord injury rehabilitation, there have been no reports of the ability of C5 quadriplegic patients to perform self-care and mobility skills before and after rehabilitation. This study was designed to examine the rehabilitation outcomes of 63 patients with C5 complete quadriplegia, who completed an interdisciplinary inpatient rehabilitation program, using the 100-point modified Barthel Index as a means of rating functional status. There were statistically significant increases in the mean modified Barthel index scores from 7.1 on admission to 28.9 on discharge for the entire group of patients. The self-care subscore increased significantly from 6.5 on admission to 20.0 on discharge and the mobility subscore increased significantly from 0.5 on admission to 8.9 on discharge. Ability to perform self-care and mobility subscore tasks is described. This study documented significant improvements in function during comprehensive rehabilitation among patients with C5 spinal cord injury.

Activities of Daily Living↗
PubMedDate not supplied

[Morbidity and cause of death in homeless persons].

The Hamburg Institute of Forensic Medicine analysed 388 deaths of homeless people between 1990 and 1998 considering demographic data, post-mortem results and autopsy findings. The manner of death was either unnatural or unascertained; the autopsy rate amounted to 43.8%. The results confirm the observation discussed in the last few years that homeless people are usually in a poor state of health. In relation to the average age of death, which is 44.5 years, the number of previous diseases is high. Unnatural causes (excluding homicides) account for a high percentage, viz. 62.6%, primarily intoxications. The most frequent natural cause of death is infection (16.8%). Women account for 8.5% of the deaths with their organ findings and causes of deaths being different from those of homeless men in terms of distribution and incidence. The data presented in this report may be helpful for the improvement of the present system of medical help in Hamburg.

Adolescent↗