PubMed Health⌕ Search

Biomedical subjects

C Sieber

Publications and source records attributed to C Sieber.

At least 19 recordsLinked to original sources
PubMed2006

[Fever in the elderly patient].

The multimorbid geriatric patient with age-related functional deficits is at particular risk from fever. Although the underlying cause is usually an infection, collagenosis, malignomas or drug-associated side effects all play an increasingly important role in patients of advanced age. In this segment of the population, the question of the reasonableness of a diagnostic work-up weighed against the expected improvement in quality of life is of particular relevance. The most common complication is dehydration, which may be followed by marked confusion. Account being taken of the requirements and the social situation of the individual concerned, any critical development should prompt early hospitalization, ideally in a geriatric hospital.

Aged↗
PubMed2006

[Geriatrics in Bavaria-Database (GiB-DAT): Conception, structure and results of implementation (part I)].

In the year 2000, a database was implemented in Bavaria, covering the majority of geriatric clinics. Benchmarking statistics are generated in quarterly periods and scientifically analyzed. Actually, 41 of the 57 geriatric clinics in Bavaria participate in the project 'Geriatrics in Bavaria-Database' (GiB-DAT). For geriatric rehabilitation, the coverage is 82.4%. In addition, all 7 geriatric day clinics participate; thus, a total of 24,000 cases are documented each year. Therefore, GiB-DAT is the largest database for geriatric rehabilitation in Germany and Europe. To make documentation more effective and easy, new software (GERIDOCTM) has been generated which is integrated in the process of daily treatment. GiB-DAT offers good data quality, especially concerning completeness of items. This manuscript describes conception and construction of GiB-DAT and identifies differences compared to the Geriatric Minimum-Dataset (GEMIDAS), a nationwide geriatric database in Germany.

Aged↗
PubMed2006

[Geriatrics in Bavaria-Database (GiB-DAT): Basic data analysis of geriatric rehabilitation in Bavaria and analysis of inter-clinic variability (part II)].

OBJECTIVE: Presentation and comparison of basic data from geriatric rehabilitation in Bavaria with analysis of statistical influences on characteristic values like length of stay and Barthel Index. Are differences between participating clinics due to patient characteristics? SETTING: There were a total of 21 656 data records of the Geriatrics in Bavaria- Database (GiB-DAT) collected by 35 clinics within 1 year. RESULTS (PERCENTAGE OR MEAN): 70.6% female patients, age 80.0 years, 95.9% enrollment from acute care hospitals, length of stay in previous hospitals 24.3 days, length of stay in geriatric rehabilitation 24.6 days. DIAGNOSIS: 41.7% orthopedics, 24.9% neurological, 33.4% others. Barthel Index on admission 44.1 points, on discharge 65.8 points (difference 21.8 points). We found a large variance of all items between participating clinics. Variance for Barthel Index and length of stay is partly cleared up by regression analysis (multinomial logistic) and is mostly due to patient characteristics. CONCLUSIONS: Basic data of Bavarian geriatric rehabilitation clinics is matching with nationwide reference statistics. Differences exist for the lower rate of stroke and direct enrollment of outpatients. A simple ranking of outcome parameters (e. g. Barthel Index) does not make sense due to multiple influencing factors.

Aged↗
PubMed2005

Acute poisoning in old and very old patients: a longitudinal retrospective study of 5883 patients in a toxicological intensive care unit.

Although morbidity and mortality of acute poisoning are increased in elderly compared to younger patients, little has been published on this topics in the last years (Medline search). To investigate the influence of age on the clinical course of acute poisoning with different toxic agents, a longitudinal retrospective study at the Toxicological Intensive Care Unit (ICU) of the 2nd Department of Internal Medicine (Klinikum Nürnberg, Germany) was performed.A total of 5883 patients treated at our toxicological ICU were enrolled into the study, including all patients of the years 1982, 1992, and 1997. These three years were selected to investigate possible time-dependent changes of intoxication characteristics and quality of therapy at our ICU over a time span of 15 years. For each patient the following data were obtained from a standardized toxicological record: age, gender, toxic agents responsible for acute poisoning, and length of stay at the toxicological ICU. For a subgroup of 3740 patients, the cause of acute poisoning and the clinical outcome was also recorded. As compared with younger patients, mean length of stay at the ICU, indicating a more serious course of acute poisoning, was prolonged in elderly and, i. e., in very old patients (p <0.001). However, this prolongation of time at the ICU was only observed in elderly patients poisoned with drugs or with mixed poisoning including drugs, while mean length of stay was not prolonged in elderly patients poisoned with alcohol, with illegal drugs, chemicals, animal/plant poison, or other toxic agents. Patients with the highest risk of dying in the ICU after acute poisoning were elderly patients attempting suicide with drugs. Mortality in 3740 patients with acute poisoning was 0.24%, while it was 2.17% in the 184 patients being 65 years old or older. Thus, mortality was 9-fold higher in the elderly. Mean length of stay at the ICU decreased significantly from 1982 to 1992 and to 1997 (p <0.001) indicating an improvement of the therapeutical ICU management of acute poisoning and/or less dangerous toxic agents (i. e. less barbiturates). The age-dependent increase of the length of stay at the ICU until very old age (> 80 years) was most pronounced in 1982 and also declined markedly until 1997.Age, suicide attempt, and ingestion of (multiple) drugs seem to be risk factors for a higher mortality and a prolonged stay in the ICU after acute poisoning. Although in general the clinical course after poisoning has more complications and an impaired prognosis in old age, each category of toxic agents (drugs, alcohol, chemicals, etc.) has its own special "risk profile" for elderly patients. However, due to advances in modern ICU medicine the general prognosis of acute poisoning is good in old and even in oldest old patients.

Acute Disease↗
PubMed2004

Sarcopenia and frailty in geriatric patients: implications for training and prevention.

Sarcopenia, the loss of muscle mass and strength, is a constant phenomenon in aging. Physiologic age-dependent changes (drop in growth hormone (GH), IGF-1, menopause/andropause) explain the impaired protein synthesis, the decline of muscle mass, strength, and bone density. Harmful consequences of sarcopenia in old age are loss of muscle strength, inducing itself loss of mobility, neuromuscular impairment, and homeostatic balance failure syndrome with gait and balance disorders. All these sarcopenia-induced disabilities are important factors for an increased rate of falls and fractures in old age. Both falls and fractures cause hospitalisation and immobilisation which again induces sarcopenia. Once the physiological age-dependent decline of protein synthesis has started, some connected "vicious loops" occur in frail elderly patients, forming a typical pattern in geriatric medicine. There is a vicious loop between sarcopenia and immobilisation: sarcopenia --> neuromuscular impairment --> falls and fractures --> immobilisation --> sarcopenia. Another loop is the "nutritional" vicious loop between sarcopenia and malnutrition: sarcopenia --> immobilisation --> decline of nutrition skills ("empty refrigerator") --> malnutrition --> impaired protein synthesis --> sarcopenia. There is also a third "metabolic" vicious loop between sarcopenia and the decline of the protein reserve of the body: sarcopenia --> decline of the protein reserve of the body --> diminished capacity to meet the extra demand of protein synthesis associated with disease and injury --> sarcopenia. Frailty, a term not precisely defined, results from these different "vicious loops" including sarcopenia, neuromuscular impairment, falls and fractures, immobilisation, malnutrition, impaired protein synthesis, and decreased protein reserve of the body. Implications for training: main possibilities for training and prevention (of sarcopenia and frailty) are: a) continuous neuromuscular training (including training of balance) b) mobilisation c) prevention of falls d) training of nutrition skills and improvement of nutrition e) improvement of the impaired protein synthesis (with hormones etc.), and f) avoidance of dangerous drugs (drugs which cause neuromuscular impairment).

Accidental Falls↗
PubMed2003

Influence of food composition on splanchnic blood flow during digestion in unsedated normal dogs: a Doppler study.

The effect of dietary components in gastrointestinal blood flow was investigated non-invasively in dogs. Doppler ultrasound (US) waveform analysis of the celiac artery (CA) and the cranial mesenteric artery (CMA) of eight healthy dogs was performed both in the fasting state and at 20, 40, 60 and 90 min after feeding maintenance, high protein, high carbohydrate and high fat diets. Resistive index (RI), pulsatility index (PI) and the percentage differences between measurements were calculated. In fasted dogs, the CA showed significantly (p<0.05) lower resistance than the CMA. With all diets, post-prandial RI and PI values decreased significantly in both vessels (CA: RI=-12-13%; PI=-25-29%; CMA: RI=-13-15%; PI=-27-29% [p<0.05]), and in all cases significantly earlier in the CA than in the CMA (p<0.05). With all diets except high fat the maximum decrease in RI and PI was reached in the CA at 40 min and in the CMA at 60 min. High fat diets were unique in that the maximum decrease in RI and PI in the CMA occurred earlier (at 20 min) and values were slower to return to normal (p<0.05). We conclude that Doppler US can be used in dogs to quantify significant differences in the response of splanchnic blood flow to different dietary components.

Animals↗
PubMed2001

Ag8 fluorescence in argon.

The fluorescence of Ag8 in an argon matrix and in argon droplets is reported. This is the first unambiguous assignment of the fluorescence of a metal cluster larger than the tetramer, indicating that the excited state lifetime is longer than previously thought. It is discussed as a possible result of a matrix cage effect. The excitation spectrum is compared with two-photon-ionization measurements of Ag8 in helium droplets and to known absorption data. The agreement is excellent. We propose that the excited states relax rapidly through vibrational coupling to a long-lived state, from which the fluorescence occurs.

Journal Article↗
PubMed2001

Prevalence of Helicobacter pylori infection in peptic ulcer perforations.

BACKGROUND: Most patients with chronic peptic ulcer disease have Helicobacter pylori (H. pylori) infection. In the past, immediate acid-reduction surgery has been strongly advocated for perforated peptic ulcers because of the high incidence of ulcer relapse after simple closure. Simple oversewing procedures either by an open or laparoscopic approach together with H. pylori eradication appear to supersede definitive ulcer surgery. METHODS: In 47 consecutive patients (mean age = 64 years, range 27-91) suffering from acute peptic ulcer perforation the preoperative presence of H. pylori (CLO test), the surgical procedure (laparoscopy or open surgery), the outcome of surgery, and the success of H. pylori eradication with a triple regimen were prospectively studied. RESULTS: Of these patients 73.3% were positive for H. pylori, regardless of the previous use of nonsteroidal anti-inflammatory drugs (NSAIDs). Thirty-eight per cent underwent a simple laparoscopic repair. Conversion rate to laparotomy reached a high of 32%. The main reasons for conversion were the size of the ulcer, and/or diffuse peritonitis for a duration of over 12 hours with fibrous membranes difficult to remove laparoscopically. In the H. pylori positive patients, eradication was successful in 96% of the cases. Mortality and morbidity rates were greater in the laparoscopic group (p < 0.05). Follow-up (median 43.5 months) revealed no need for reoperation for peptic ulcer disease and no mortality. CONCLUSION: We have found a high prevalence of H. pylori infection in patients with perforated peptic ulcers. An immediate and appropriate H. pylori eradication therapy for perforated peptic ulcers reduces the relapse rate after simple closure. Response rate to a triple eradication protocol was excellent in the hospital setting.

Adult↗
PubMed2001

Aging research in Switzerland.

The present review on aging research in Switzerland describes ongoing gerontological and geriatric research in the field of both basic science and clinical research. Although Switzerland is situated at the rear end of the scale in regard of size or number of inhabitants, the number of high quality research groups per inhabitant positions it amongst the leading countries in the Western world. Being a small country Switzerland counts only five universities with clinical affiliations. Aging research in Switzerland therefore does not cover all areas of this rapidly developing discipline but some of the scientific contributions are mirrored in highest scored journals or others focus on topics that clearly bridge geriatric research and research on cellular and molecular mechanisms of aging.

Aging↗
PubMed2001

[Contraception in immigrant women].

The contraceptive behaviour of immigrants is not enough reliable if the great number of abortions is considered. Possible explanations for this fact are immigration itself but also the cultural background. Within the practical guidelines for transcultural contraceptive counselling, the most important points are a low access limit, the use of translators and mediators familiar with the subject, enough time and a high motivation.

Adolescent↗
PubMed2000

Refrigerator content and hospital admission in old people.

We assessed whether the refrigerator contents of elderly people could be related to subsequent admission to hospital. 132 patients aged over 65 years had a thorough assessment of their refrigerator contents and the numbers and dates of admission were recorded. Elderly people with empty refrigerators were more frequently admitted (p=0.032) in the month after assessment and three times sooner than those who did not have empty refrigerators (34 vs 100 days, p=0.002).

Aged↗
PubMed2000

[Portal hypertension and angiogenesis].

The pathophysiological background of the haemodynamic changes in chronic portal hypertension is still only partly understood. An important factor is the so-called "forward theory", explaining the systemic and especially splanchnic vasodilation observed. Nitric oxide (NO) is an important mediator of this vasodilatory state. Structural as well as vascular changes seem to be causative factors in this vasodilation. These alterations can be studied by a newly-developed in vivo angiogenesis assay. Rats with portal hypertension show increased angiogenesis and NO appears to be a mediator of this finding. The interaction(s) of NO with other angiogenic molecules is now being explored. A better understanding of these structural vascular changes may help to develop new therapeutic strategies in the future.

Animals↗
PubMed2000

Complete dysphagia after thrombolytic treatment for myocardial infarction.

An 82 year old man was admitted to hospital with unstable angina pectoris. There was a long history of minor symptoms suggesting reflux disease, with a small diaphragmatic hernia. One day after admission the patient complained of severe chest pain. An acute inferior-posterior myocardial infarction was diagnosed on ECG, and thrombolytic treatment with alteplase (rt-PA) was initiated. Within a few hours total dysphagia occurred, caused by haemorrhagic oesophagitis. The haematoma resolved spontaneously within about 10 days. The patient was discharged three weeks later after full resolution of the dysphagia.

Aged↗