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Biomedical subjects

E Biermann

Publications and source records attributed to E Biermann.

At least 19 recordsLinked to original sources
PubMed2003

Semi-automatic generation of medical tele-expert opinion for primary care physician.

OBJECTIVES: A computer-based system has been developed for the generation of medical expert opinions on the insulin-resistance syndrome, based on clinical data obtained from primary care physicians. METHODS: An expert opinion for each patient was generated by using a decision tree for entering individual text modules and by adding optional free text. The expert opinions were returned by e-mail, telefax or by ordinary mail. RESULTS: 1389 primary care physician sent anonymous data sets and requested expert opinions for a total of 3768 patients. Through the set up of a rule-based system an automation of the generation of the expert opinions could be achieved and the generation time dropped from initially 40 minutes to less than 5 minutes at the end. CONCLUSIONS: By using predefined text modules and a rule based system, a large number of medical expert opinions can be generated with relatively few additional resources.

Data Collection↗
PubMed2002

The efficacy of Ginkgo special extract EGb 761 in patients with tinnitus.

OBJECTIVE: The objective of the present study in 60 patients with chronic tinnitus aurium was to confirm the efficacy of oral treatment with 2 x 80 mg Ginkgo special extract EGb 761 per day subsequent to 10-day EGb 761 infusion treatment. METHODS: Patients with chronic tinnitus aurium underwent 10 days of in-patient infusion treatment with 200 mg/day EGb 761, after which they were randomized to double-blind, oral out-patient treatment with either 2 x 80 mg/day EGb 761 or placebo, given over a scheduled treatment period of 12 weeks. The primary outcome measure was the change in tinnitus volume in the more severely affected ear during randomized treatment. RESULTS: Fifty-two of 60 patients (89.7%) completed the infusion treatment; complete sets of data were available for 40 (66.7%), 30 (50.0%) and 22 (36.7%) patients after 4, 8 and 12 weeks of randomized treatment, respectively. For the primary outcome measure, significant superiority of EGb 761 over placebo was demonstrated in the intention-to-treat analysis data set after 4, 8 and 12 weeks of out-patient treatment (p < 0.05, 1-tailed), although the absolute treatment group difference was moderate. The results were supported by the secondary outcome measures for efficacy (e.g. decreased hearing loss, improved self-assessment of subjective impairment). During out-patient treatment, there were no attributable adverse events under EGb 761. CONCLUSIONS: A combination of infusion therapy followed by oral administration of Ginkgo special extract EGb 761 appears to be effective and safe in alleviating the symptoms associated with tinnitus aurium.

Administration, Oral↗
PubMed2001

[Surgical treatment of differentiated thyroid gland carcinoma. Technique and morbidity in paratracheal lymph node excision].

BACKGROUND: The extent of cervical lymphadenectomy in treatment of differentiated thyroid cancer is controversial. Technique and results of paratracheal lymphadenectomy are presented to demonstrate safety of cervical lymphadenectomy procedures. PATIENTS AND METHODS: 68 Patients with differentiated thyroid cancer underwent total thyroidectomy and extended lymphadenectomy in a standardized technique. The pre- and paratracheal and the lateral lymph node compartments were cleared. RESULTS: Permanent pareses of recurrent laryngeal nerve or permanent hypocalcaemias were not observed. 3 patients developed transient recurrent nerve palsy, 26 patients transient hypocalcaemia (Ca2+ > 1.7 and < 2.2 mmol/l). In 3 patients mild voice disturbances, probably due to superior laryngeal nerve dysfunction were observed. In 1 patient short-time tracheotomy was performed. 1 patients showed permanent Horner's syndrome. CONCLUSIONS: Thyroidectomy with extended lymphadenectomy achieves removal of all cervical tumor masses without relevant morbidity. The distribution of metastatic lymph nodes underlines the necessity of extended lymphadenectomy.

Follow-Up Studies↗
PubMed2000

Telecare of diabetic patients with intensified insulin therapy. A randomized clinical trial.

BACKGROUND: Patients with insulin dependent diabetes require frequent advice if their metabolic control is suboptimal. A telemedical system for transmission of self monitoring blood glucose values from the patients' home to the diabetes center with a combined modem-interface is described. Data are processed by PC and advice is given by telephone. The study focuses on metabolic outcome, fiscal and administrative aspects. METHODS: A prospective, randomized trial with 46 patients with intensified insulin therapy was conducted, 30 patients used telecare and 16 conventional care. RESULTS: HbA1c, as a parameter of metabolic control, dropped from 8.3% to 7.3% in the telecare group and from 8.0% to 6.8% in the conventional group after 8 months of observation. There was no significant difference between the two groups. Time expenditure for telemanagement, compared to conventional advice, was moderately higher, but there was a substantial amount of time on the patients side that could be saved mainly by reduction of to travel time and work stoppage. Setting up an optimal telemanagement scenario a cost analysis was done. This yields a cost saving of about 650 EURO per year. CONCLUSION: Telemanagement of insulin-requiring diabetic patients is a cost and time saving procedure for the patients and results in metabolic control comparable to conventional outpatient management.

Adult↗
PubMed1997

[Transoral metal implant removal after ventral C2/C3 spondylodesis in pharyngo-vertebral fistula].

A 26-year-old man sustained a C2 arc fracture. Ventral spondylodesis using an H-plate was performed. The patient developed a pharyngovertebral fistula which remained undetected for 1 year. Spontaneous fusion of C3/C4 and osteolysis of the cortical block occurred. The fistula was demonstrated intraoperatively and the implant was transorally removed. No further problems occurred after this unusual method of treatment. The anatomy of the cervical spine, special problems of intensive care patients and the use of proper instrumentation are discussed.

Adult↗
PubMed1997

[Damage due to patient positioning in anesthesia and surgical medicine (1)].

Positioning a patient for surgery requires great care and caution. Correct positioning provides the surgeon with good access to the site, minimizes blood loss and reduces the risk of damage to nerves, soft tissue, compartments and the cardio-pulmonary system. Each position has its specific risks. These have to be evalued against the benefits. Extreme positions of the joints should be avoided whenever possible. The ulnar nerve or the plexus brachialis are at highest risk in the positioning of extremities. Good anatomical comprehension makes it possible to take effective counter-measures. In the case of damage to the ulnar nerve in spite of optimal positioning, some authors found pre-existent non-symptomatic dysfunction in up to 30% of the cases. Patients suffering from peripheral vascular disease are usually at higher risk to suffer acute ischaemia, or, in the extreme, rhabdomyolysis with compartment syndrome, when positioned with elevated extremities (as in lithotomy position) or when a tourniquet is applied. Next to other factors, the duration of surgery seems to be of some importance. Operation sites above the heart carry a higher risk of venous air embolism unrelated to the positioning. In these cases adequate monitoring should be generously applied. Loss of visus is a rare but very severe complication most often seen in connection with the prone position. Still, postoperative blindness has occurred in all positions. It is absolutely imperative to avoid all pressure to the bulbus. The same law applies to surgery and positioning: indicated and correctly executed positioning, to which the patient has effectively consented, is legal, even if damage should occur. If the plaintiff demands compensation for damage, the distribution of onus of proof depends essentially on the accuracy of documentation. If documentation is faulty, the plaintiff may be granted relief or even shift of the onus of proof. This does not apply to a criminal lawsuit; in that case, culpable medical fallibility must be proven, since otherwise, the principle of "in dubio pro reo" applies. The interdisciplinary responsibilities concerning the positioning must be clearly defined and it is essential that the documentation of positioning as well as the documentation of positioning control is carried out as accurately as possible. Correct positioning can effectively aid surgery. Slovenly positioning should not be accepted, as there is a high probability of ill effects, possibly of permanent damage.

Anesthesia, General↗
PubMed1997

[Pneumocystis carinii otitis].

BACKGROUND: Pneumocystis carinii (PC) otitis is a rare opportunistic infection of the acquired immunodeficiency syndrome (AIDS). Initially hearing loss and otalgia occur with thickening of the tympanic membrane and the bordering skin of the ear canal. Otorrhea, ear polyps, perforation of tympanic membrane, destruction of mastoidal bone, and participation of cranial nerves are observed. Diagnosis is established histologically. The treatment of the parasite is by trimethoprim-sulfamethoxazole combinations. The immunological situation seems to be better than in PC pneumonia. Due to the underlying immunological incompetence the infection can not be expected to limit itself. To prevent severe complications as sequestrating mastoiditis, early diagnosis and specific surgical and medical treatment are necessary.

AIDS-Related Opportunistic Infections↗
PubMed1995

The efferent innervation of outer hair cells in humans: physiological investigations.

We report on a case of reversible pontine deafness caused by multiple sclerotic lesions in the pons, and describe six experiments in humans, in whom we recorded transient otoacoustic emissions and distortion products. Our findings indicate an inhibitory effect of efferent innervation on the motility of outer hair cells in humans. Otoacoustic emissions increased in patients with unilateral deafness after the central part of the efferent pathway was destroyed (pontine deafness). Otoacoustic emissions also increased in patients with myasthenia gravis after the administration of an acetylcholinesterase inhibitor. General myotonia (Batter-Curschmann-Steinert Syndrome) resulted in mild sensorineural hearing loss, and in the absence of contralateral inhibition of otoacoustic emissions. Otoacoustic emissions decreased gradually under general anesthesia with muscle relaxation. Contralateral acoustic stimulation was seen during anaesthesia with muscle relaxation.

Acoustic Stimulation↗