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Biomedical subjects

C Ohmann

Publications and source records attributed to C Ohmann.

At least 109 records · Page 6Linked to original sources
PubMed1992

Acute cholecystitis: a complication in severely injured intensive care patients.

Acute cholecystitis is an often unrecognized and potentially life-threatening complication seen among ICU patients with multiple injury. To investigate the epidemiology of this entity and to evaluate significant etiologic precursors, a prospective clinical and sonographic study was performed in 45 consecutive patients (mean age, 29 years) treated for multiple trauma (mean ISS, 27) in the ICU. Eight of 45 patients developed a cholecystitis during intensive care treatment (18%). Six patients recovered with conservative therapy; in two instances a cholecystectomy was necessary. There was no mortality as a result of cholecystitis. A significant relationship between the severity of the initial trauma (p less than 0.05), the number of blood transfusions (p less than 0.01), and the incidence of acute cholecystitis was found. Other factors such as prolonged shock, respiratory failure, or parenteral alimentation were less prevalent and were not temporally related to the onset of the disease. All patients had large amounts of narcotics administered over a prolonged period, so that narcotic-induced biliary stasis appeared to be another eminent factor involved in the genesis of posttraumatic cholecystitis. Our results lead to the conclusion that acute cholecystitis occurs with an unexpectedly high incidence and that a high remission rate can be expected following conservative treatment provided that appropriate serial ultrasound examinations are performed.

Acute Disease↗
PubMed1992

Incidence and pattern of peptic ulcer bleeding in a defined geographical area. DUSUK Study Group.

Despite the introduction of effective medical treatment for peptic ulcer disease, no decrease in the incidence of bleeding has been observed. Unfortunately, most incidence studies rely on a questionable case ascertainment and poor data. We therefore conducted a prospective study, to achieve an unbiased estimate of incidence and pattern of peptic ulcer bleeding in Düsseldorf (Germany). In a 1-year period all patients with endoscopically verified peptic ulcer bleeding who were admitted to the departments of internal medicine or surgery in nine hospitals or seen by nine general practitioners offering endoscopic service were included in the study. Incidence rates were calculated in accordance with sociodemographic variables and expressed per 100,000 person-years of observation. The overall incidence of peptic ulcer bleeding was 51.4, with almost even rates for gastric (26.5) and duodenal (24.9) ulcer. Age was associated with an increased likelihood of bleeding in gastric ulcer patients of 19 per decade from about 40 years onwards (duodenal ulcer, 15). The incidence was about twice as high in men as in women (relative risk = 1.9). The pattern of peptic ulcer bleeding was similar in gastric and duodenal ulcers with regard to ulcer size, multiple lesions, and bleeding activity at endoscopy. However, patients with gastric ulcer bleeding had significantly more often accompanying or underlying diseases. No significant differences were observed between gastric and duodenal ulcer bleeding with regard to nonsteroidal antiinflammatory drug intake and ulcer history. The incidence rates in our study are in the upper range of the literature and comparable to rates from the USA and UK both before and after the introduction of H2 blockers. We hypothesize that the persistently high incidence rate is a superposition of two trends: higher incidences due to a more elderly and diseased population and more NSAID intake, and lower incidences due to effective medical treatment.

Adult↗
PubMed1992

[Formal decision aids in gastroenterology--results of a survey].

Formal decision aids such as scores, decision-trees and expert systems, are recommended for supporting research and daily clinical work. In the field for gastroenterology it is unknown, to which degree these tools are accepted and applied in clinical routine. We therefore conducted a mail survey in order to find out whether clinical gastroenterologists know, use or want formal decision-aids. To all clinical members of a german gastroenterological scientific society (Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten, n = 584) an information leaflet and a questionnaire was sent. The form contained questions about use, knowledge and requests with respect to decision-aids in gastroenterology and concerning the attitude to computerized decision-aids in general. 584 clinicians received the questionnaire, 215 sent it back for analysis (39%). Formal decision-aids were used by half of the survey participants (56%), mainly three scores (Child-Pugh, Best and other indices for inflammatory bowel disease, Ranson) and four classifications (TNM, Forrest, Savary-Miller, Paquet). Computer-based formal decision-aids (e.g. expert systems) were used by a minority. Clinicians, who applied formal decision-aids stated more frequently a request for further decision-aids (72%) than those who did not (46%). A considerable part of the survey participants believed that computerized decision-aids will come into clinical routine (52%) and will improve education (37%) and clinical practice (35%). 88% were convinced, that decision-aids should be tested in controlled clinical trials before a clinical use can be recommended. There is a discrepancy between propagation of formal decision-aids and it's clinical use. Only a few scores and classifications are used in clinical routine.(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial Intelligence↗
PubMed1992

[Acute abdominal pain--standardized findings as diagnostic support. Results of a prospective multicenter intervention study and testing of a computer-assisted diagnosis system].

Despite powerful diagnostic tools (e.g. ultrasound, special laboratory investigations), the diagnosis of acute abdominal pain is still a considerable problem. Several studies in the UK have shown that the diagnostic accuracy can be improved by structured and standardized history taking and clinical examination and by computer-aided diagnosis. In the framework of a concerted action of the European Community we have conducted a prospective multicenter interventional trial comparing two consecutive phases: a) a baseline phase in clinical routine without additional intervention, b) a test phase with structured and standardized history and clinical examination (questionnaire, documentation programme). In addition, a computer-aided diagnostic system developed in the UK was applied to the cases in the test phase. Outcome criteria were the diagnostic accuracy of the initial and the final examiner, the perforated appendix rate, the negative appendectomy rate, the negative laparotomy rate and the rates of diagnostic errors with missing indication to operation and of delayed urgent operations. No differences could be found between the phases with respect to the outcome criteria. In the baseline phase (test phase) diagnostic accuracy was 59% (59%), diagnostic accuracy after investigation (senior examiner) was 77% (78%), perforated appendix rate was 11% (16%), negative appendectomy rate was 13% (15%), negative laparotomy rate was 7% (8%), the rate of missed urgent indications to operation was 1.1% (1.9%) and the rate of delayed urgent operations was 3.4% (2.4%). Major differences between the centers were recorded. Computer-aided diagnosis resulted in a diagnostic accuracy of 51%. The introduction of structured and standardized history taking and clinical examination has not brought any improvement of the good results in clinical routine. It is doubtful, whether existing systems of computer-aided diagnosis are able to significantly decrease the still remaining error rate of 20%.

Abdomen, Acute↗
PubMed1991

[Clinical results of Palmer's primary cruciate ligament insertion without augmentation].

The clinical importance of primary cruciate ligament reconstruction without augmentation-plasty is discussed on the background of long term results following 51 operations. Based on standardized methods of evaluation 38 patients had a very good and good result, in eleven cases the operation lead to a fair and in two cases to a poor result. A significant instability with a pivot shift grade III was recorded in two cases: twelve patients showed a low degree of instability whereas 37 patients had regained full stability. The coincidence of a cruciate ligament lesion and a rupture of a collateral ligament had a negative influence on the postoperative long term result (p less than 0.01). Our results suggest that a primary repair without augmentation-plasty is a qualified procedure for stabilizing the knee joint in cases with an acute femoral rupture without accompanying collateral lesions. In patients with old ruptures or a complex joint lesion primary repair with augmentation is recommended.

Evaluation Studies as Topic↗
PubMed1991

Diagnostic emergency endoscopy in upper gastrointestinal bleeding--do we have any decision aids for patient selection?

The benefit of emergency endoscopy and therapeutic policies based on certain stigmata of bleeding has recently been demonstrated in patients with peptic ulcer hemorrhage. Applying a simple method of computer-aided diagnosis to a set of prospective data (n = 571) we investigated the question as to whether information on the history (28 variables) and clinical examination (8 variables) could be used to predict ulcer bleeding or certain stigmata of bleeding, with a view to deciding when to perform an emergency endoscopy in patients with upper gastrointestinal bleeding. The patients were assigned to either a high-risk group (probability greater than 0.50 for ulcer bleeding, arterial bleeding, etc.) or a low-risk group (p less than 0.50), and the prediction was compared with the actual findings at endoscopy. The results were disappointing, with an overall accuracy of 71% for the prediction of bleeding peptic ulcer and 71% for the prediction of a bleeding or non-bleeding visible vessel. Despite a relative risk of 2.8 for "bleeding ulcer" and 2.5 for "visible vessel" in the high-risk group, only 72% of all "bleeding ulcer" patients, and 69% of the "visible vessel" patients could be identified by the model. These results indicate that neither a bleeding ulcer nor stigmata of bleeding can be reliably predicted by the patient's history and clinical examination. Emergency endoscopy should therefore be performed in all patients with gastrointestinal bleeding.

Diagnosis, Computer-Assisted↗
PubMed1990

Prognostic scores in oesophageal or gastric variceal bleeding.

Numerous scoring systems have been developed for the prediction of outcome of variceal bleeding; however, only a few have been evaluated adequately. The object of this study was to improve the classical Child-Pugh score (CPS) and to test other scores from the literature. Patients (n = 82) with endoscopically confirmed variceal bleeding and long-term sclerotherapy were included in the study. Linear logistic regression (LR) was applied to different sets of prognostic variables with regard to 30-day mortality. In addition, scores from the literature were evaluated on the data set. Performance was measured by the accuracy and receiver-operating characteristic curves. The application of LR to all five CPS variables (accuracy, 80%) was superior to the classical CPS (70%). LR with selection from the CPS variables or from other sets of variables resulted in no improvement. Compared with CPS only three scores from the literature, mainly based on subsets of the CPS variables, showed an improved accuracy. It is concluded that CPS is still a good scoring system; however, it can be improved by statistical analysis using the same variables.

Esophageal and Gastric Varices↗
PubMed1989

[The effect of preoperative parenteral nutrition on the perioperative course in patients with esophageal cancer].

In 35 consecutive patients who underwent esophagectomy for malignancy the nutritional status was evaluated. 15 patients were estimated to be malnourished and were therefore treated by total parental nutrition (TPN) for 7 days. In the control group (n = 20, no TPN) the nutritional status was normal. TPN corrected abnormal serum parameters with short half-life time. Therefore the nutritional status of both groups was equal at time of operation. The postoperative clinical outcome of both groups was as follows: In TPN-treated patients postoperative hospital stay for 26 days was shorter compared to 32 days in controls, no patients died (vs n = 4), no patient developed sepsis (vs n = 4), no patient developed acute renal failure (vs n = 3). These differences did not reach levels of significance due to the small patient groups. In conclusion our study shows that patients with esophageal cancer and regarded as well nourished seemed to suffer from nutritional deficits. Assessment of the nutritional status by commonly used nutritional parameters does not reveal these deficits.

Adult↗
PubMed1989

Preventing recurrent postoperative adhesions: an experimental study in rats.

A peritoneal lavage model, cyclic intraperitoneal lavage (CIPL), and other adhesion preventing methods with and without fibrinolytic agents were compared to a control group without treatment in an animal study. The adhesion-preventing effect was evaluated at the site of a standardized peritoneal defect (free peritoneal grafting, P) and at the laparotomy wound (L) of 60 rats (12 escape) after surgical lysis of primary adhesions during relaparotomy In five test groups with different treatments and in a control group without treatment recurrent adhesions were investigated during relaparotomy according to an adhesion grading scale with increasing severity (O-III). In the control group only severe adhesions grade II and III were observed. The five test groups showed different distributions of grade 0-II adhesions: compared to the control group a significant difference of the preventing effect was seen after CIPL with 1.36% glucose solution (as used for peritoneal dialysis) and after CIPL with Ringer's solution at the sites P and L, after a one-time irrigation with Ringer's solution only at the peritoneal graft P. Fibrinolytic agents used in CIPL or as single dose application failed to show an improvement compared to the control group.

Animals↗
PubMed1989

[Computer-assisted documentation in upper gastrointestinal endoscopy: experiences with routine use at 3 clinics].

The introduction of powerful and inexpensive personal computers (PC) enabled us to develop a documentation system for upper gastrointestinal endoscopy. The system was programmed using the database management system dBASE III. It works on-line, and no computer knowledge or additional staff is needed to run the system. It is now routinely used in the endoscopic units of three different hospitals. Features of performance are a menu-driven data input, automatic report generation and record retrieval, listing according to different criteria as well as other dBASE III facilities. This paper deals with the quality, time effort and user acceptance of the PC-aided system in clinical routine. The analysis showed a good data quality with respect to completeness and adequate use of terminology. Reliability and validity of the documentation were satisfactory considering the methodological problems encountered at their determination. The system was generally judged useful, but time effort was increased compared to conventional documentation.

Documentation↗
PubMed1989

[Various strategies in the diagnosis and therapy of thyroid gland cancer. Results of a survey].

In a questionnaire we compared generally adviced therapeutical and technical procedures in patients with thyroid carcinomas with the actually favorized strategy of the clinically active surgeons. At present, sonography and cytology are not favored as preoperative diagnostic tools by the questioned surgeons. Hemithyreoidectomy as primary procedure in suspicious nodules is performed only seldomly. In the treatment of thyroid carcinoma total thyroidectomy is the accepted procedure and the possibility of restricted radicality in the treatment of papillary thyroid carcinomas has gained wide acknowledgement. Most surgeons prefer to visualize the recurrent nerve and at least one or two parathyroid glands. Autotransplantation of parathyroid glands with insufficient blood supply is considered only seldomly.

Adenocarcinoma↗
PubMed1988

Prediction of risk for pseudoallergic reactions and histamine release in patients undergoing anaesthesia and surgery: a computer-aided model using independence-Bayes.

A computer-aided model for the prediction of pseudoallergic reactions was developed using prospective data collected from 581 patients in a controlled clinical trial examining pseudoallergic reactions to the plasma substitute Haemaccel (outdated formulation). The multivariate analysis of 22 proposed risk factors was performed using Bayes theorem. This enabled the accurate prediction of 86% of the patients who had a systemic reaction. The clinical use of such system would enable a selection of patients to receive the effective prophylactic measure of pretreatment with H1 plus H2-receptor antagonists.

Anesthesia↗
PubMed1988

Do the stigmata of recent haemorrhage have additional prognostic value in patients with bleeding duodenal ulcer?

To assess the additional prognostic value of endoscopic stigmata of recent haemorrhage (SRH) in addition to clinical data, a pilot study was conducted on 207 duodenal ulcer patients from the OMGE survey. The incidence of SRH was compared in 145 patients who settled and 62 who re-bled. Only active bleeding emerged as significantly commoner in the latter group. Two computer-assisted predictions of further bleeding (before and after addition of the stigmata to a clinical database) were compared with the final outcome. Little improvement, in terms of prognosis for further bleeding, was obtained when SRH data were added. Similar findings were observed in a smaller series from Marburg, FRG.

Diagnosis, Computer-Assisted↗
PubMed1988

[Perioperative risk from the viewpoint of the surgeon. Analysis and clinical use].

General definitions are proposed in this paper for the terms of risk and risk factor. Risks are then analysed, with reference to the literature, on the basis of the defined terminology. Possible approaches are then demonstrated for clinical translation of risk analyses into appropriate therapeutic concepts, with reference being made to a study of oesophageal carcinoma. The benefit has been persuasively reflected in reduced lethality.

Colonic Neoplasms↗
PubMed1988

[Computer-assisted diagnosis].

Numerous models of computer-aided diagnosis have been developed. However, only a few are used in the clinical routine. The methodology of computer-aided diagnosis is described briefly in this paper and a survey of clinical applications is given. Standards for evaluating these models are proposed and illustrated by examples. The inadequate assessment of most diagnostic systems is one of the main reasons for their limited clinical use. New methodological and technical developments will lead to more clinical applications, if the systems are evaluated adequately.

Diagnosis, Computer-Assisted↗