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Biomedical subjects

E Biermann

Publications and source records attributed to E Biermann.

36 records · Page 2Linked to original sources
PubMed1995

[Legal liability in consultation of physicians of different specialties from the legal viewpoint].

Modern medicine is unthinkable without medical teamwork with differentiated cooperation. The horizontal division of the work, meaning the cooperation of physicians from different specialties on the basis of an equal order and the equal right in giving instructions, has to be differentiated from the relationship of subordinate and senior physicians in the vertical division of work which may be found in the relationship between the coordinator, subordinate physicians and the medical assistant staff. However, the danger of mistakes increases with the number of involved specialists. On one side, the jurisdiction has to protect the patient from the typical dangers of the division of work but has to protect the physician from an excessive liability for the malpractice of others on the other side. The necessary medico-legal rules in the area of the horizontal cooperation, after modification in the vertical cooperation as well, are the principle of a strict separation of work and the principle of trust. According to the principle of a strict separation of work, every specialist independently carries out the tasks entrusted to him without the right to instruct or supervise other specialists. The principle of trust means that every specialist may rely on the fact that the other partners will carry out their tasks with the necessary care. The limitations of trust are reached in a certain situation when a partner is not able to accomplish his tasks, i.e. due to incompetence, fatigue, or illness. Then, the physician, which is actually not in charge, has to act. Overlapping areas between the specialties should be discussed on-site or should be regulated by interdisciplinary agreements.

Clinical Competence↗
PubMed1994

DIACATOR: simulation of metabolic abnormalities of type II diabetes mellitus by use of a personal computer.

A computer program has been developed to simulate non-insulin-dependent diabetes mellitus (type 2). This disease is characterized by an impaired function of the pancreatic beta-cell and by an insufficient insulin sensitivity of the peripheral tissue. The program simulates the dependences of glucose utilization, glucose production and serum insulin level as a function of glucose and insulin and displays the results as curves on the screen. Six different states of diabetes/glucose intolerance as well as a healthy state can be selected. Renal glucose excretion can be adjusted by selection of the glomerular filtration rate. Action of sulphonylureas are simulated by changing the insulin secretion rate of the beta-cell, biguanides enhance sensitivity of the peripheral tissue for insulin and Acarbose delays glucose absorption from the intestines. Model parameters are taken from the literature. The program can be used for computer-aided medical education and for simulation of special problems in research.

Acarbose↗
PubMed1994

[Current legal questions in relation to autologous blood transfusion and legally controlled blood donation in Germany].

If a patient suffers any damage from treatment, the persons involved in transfusion medicine might be made liable according to civil and penal law for violations against the standards prescribed by the codes of performance and ethics of the individual professions. In order to avoid organisational liability, criteria for adequate patient care must be created which regulate facilities and equipment as well as staff. The typical hazards encountered in interdisciplinary cooperation between specialists of various branches of medicine must be counteracted by a constructive division of tasks and responsibilities. The participating physicians are moreover liable within the scope of the German law forbidding so-called 'unlawful interference with the possession of another' in the case of failure to obtain legally binding consent--usually resulting from inadequacies in informing the patient. The landmark decision by the German Federal Court of Justice on instructing patients about the risks of and alternatives to blood transfusions forces all those involved to take the consequences with regard to instructing patients about the risk of transfusions and concerning the implementation of techniques for sparing and replacing allogenic blood.

Blood Donors↗
PubMed1994

[Legal aspects of ambulatory surgery].

Ambulatory surgery has to be carried out with the same care as inpatient treatment with regard to the forensic aspects. As Weissauer reported, the specific forensic risk of ambulatory surgery consists in the fact that it's typical medical risks will be easily underestimated. Ambulatory surgery makes great demands on preparation, plan and performance of operation as well as on postoperative care and patient information and medical advice.

Ambulatory Surgical Procedures↗
PubMed1990

[Effect of erythrocyte contamination on thrombocyte storage].

The influence of red cells on the storage of platelet concentrates (PC) is still questionable. Therefore, we investigated 40 PCs with 4 different red cell concentrations (less than or equal to 5000, 10,000, 50,000 and 100,000/microliters), but equal leukocyte contamination, in a paired study during 5 day storage. In correlation to the red cell contamination, there was a significant reduction of platelets, discoids and especially "functional active" platelets already after addition of the red cells, which was due to a spontaneous platelet aggregation. The difference increased during the storage (p less than 0.05 and p less than 0.001). The other parameters investigated (pH, aggregation, adherence, beta-TG) showed the well-known storage alterations, but no special influence of the red cells. Therefore, PCs should contain the least red cell contamination for storage purposes.

Blood Preservation↗
PubMed1990

Separation of platelet concentrates (PC) from buffy coat (BC) using the bottom and top drainage (BAT) system.

By the preparation of platelet concentrates (PC) from buffy coat (BC), the blood component separation may be improved considerably. One can use new bag systems with bottom and top drainage (BAT) which allow partial automation of the separation procedure. Thus, it is possible to produce very pure red cell concentrates (RCC) and FFP, as well as BC, by one separation step under well standardized conditions. Several preparative factors influence the quality of the PCs, especially the storage of the whole blood and the BC. Optimal yields (0.72-0.78 x 10(11) platelets), separation efficiency (67.7-70.8%) and lowest cell contamination (leukocytes 0.1-0.2 x 10(8), red cells 0.2-0.3 x 10(8) per concentrate) were obtained with whole blood stored for 1 h and BC for 2-4 h before resuspension by 30 min face-over-face-rotation. In respect to the release of leukocyte proteases during the storage, the BC should not rest for more than 2-3 h before separation of the platelets in order to prevent potentially functional impairment of the platelets by leukocyte proteases.

Blood Component Removal↗
PubMed1989

Glucose sensors in a control circuit: a modeling study.

To draw conclusions for an optimal application and design of glucose sensors, a modeling study of glucoregulation including an intracorporal sensor in diabetics was performed. Several significant disturbances entering the artificial control loop were identified. Their influence on the control behaviour and interactions of sensor response time and noise were studied.

Algorithms↗
PubMed1989

[Changes in psychophysical parameters in relation to computer screen control work sites].

Exceptionally high demands on the psychonervous system of those engaged in certain regulatory capacities at the fluorescent screen are the order of the day. In such work, reliability of performance depends on the state of activation of the ions. Findings from the simultaneous measurement of critical fusion frequency and heartbeat frequency can be used to map out the state of activation of the ions. Optimum performance may be maintained at work for a period of up to five hours. After five hours under especially exacting working conditions, flicker frequency and heartbeat frequency were found to go into opposing phases.

Adult↗
PubMed1989

[The relation of qualifications, performance standards and psychological stress in trainees in the control service].

The psychophysical strain in control service in beginners is by means of a longitudinal study analysed by somatic and psychical strain indicators. Based on the results, the function must be assessed to be of increased psychical strain. Training and education as methods for completion of the supposition of the performance are of decisive influence on the psychical strain.

Achievement↗
PubMed1988

Improvement of blood component quality--automatic separation of blood components in a new bag system.

We report here on a new multiple bag system with top and bottom drainage of the primary bag which allows automatic separation of blood components on a routine basis. 100 units of 450 ml fresh whole blood (CPD) were centrifuged by hard spin centrifugation and then separated into leukocyte-poor red cell concentrates in additive solution (volume 284 +/- 22 ml, Hct 63.5 +/- 3.2%, platelets 3.1 +/- 1.4 X 10(9)/unit [3.1 +/- 1.2%], leukocytes 1.9 +/- 1.2 X 10(8) [8.3 +/- 5.0%]) and plasma (FFP) with acceptably low cell contamination (volume 262 +/- 33 ml, platelets 14.6 +/- 5.6 X 10(3)/microliter, leukocytes 0.04 +/- 0.03 X 10(3)/microliter). The residual buffy coat of whole blood stored for 16-20 h at room temperature was suitable for the preparation of leukocyte-poor platelet concentrates (n = 20; platelets 0.67 +/- 0.17 X 10(11) (69.8 +/- 15.0%); leukocytes 0.1 +/- 0.1 X 10(8] which showed quite good platelet function in vitro. The removal of leukocytes and platelets caused significantly less in vitro hemolysis during storage when compared to conventionally prepared red cell concentrates with and without buffy coat. Further advantages of the reduction of the cell contamination in red cell concentrates before storage are discussed. From this it can be concluded that leukocyte-poor red cell concentrates with less than 20% residual leukocytes should become the regular red cell preparation also for surgery, especially as the recommended separation technique can easily be performed on a routine basis. Red cell concentrates still containing the whole buffy coat are no longer acceptable.

Adenosine Triphosphate↗
PubMed1987

Sustained normoglycemia and remission phase in newly diagnosed type I diabetic subjects. Comparison between continuous subcutaneous insulin infusion and conventional therapy during a one year follow-up.

After onset of type I diabetes 7 diabetics were randomized to subcutaneous insulin pump treatment (CSII) (age 12 to 29 years, mean: 21 years) and 7 diabetics to conventional insulin treatment (CI) (age 14 to 28 years, mean: 21 years). HbA1, glycosylated serum proteins and mean blood glucose (MBG) as parameters of metabolic control were determined monthly. After 2 months both groups showed HbA1 values in the normal range. Mean MBG values were (mean +/- SD) 116 +/- 7 mg/dl for CSII and 118 +/- 14 mg/dl for CI. Residual insulin secretion was determined monthly by fasting C-peptide. After 14 days, 5, 7, 8 months fasting C-peptide values were significantly (P less than 0.05) higher in CI. After one year fasting C-peptide was comparable in both groups (CSII and CI mean: 0.06 nmol/l). The administered insulin dose was comparable in both groups with a 55% reduction of insulin dose after 5 months in CSII (0.35 +/- 0.15 U/kg/24 h) and in CI after 7 months (0.31 +/- 0.28 U/kg/24 h). After 12 months of insulin therapy about 60% of the initial insulin dose was injected in both groups. 1 patient on CSII (12 years) and 2 patients on CI (15, 28 years) showed a complete remission (for 3-9 months) with no exogenous insulin and normal HbA1 values. 50% of the patients had episodes where they did need less than 0.2 U/kg/24 h insulin to maintain optimal diabetic control (3 CSII, 4 CI). During the first year of insulin treatment in type I diabetes with CSII as well as with CI a comparable near normalisation of diabetic control could be achieved.

Adolescent↗
PubMed1982

Relation of insulin receptor occupancy and deactivation of glucose transport.

Kinetics of association and dissociation of 125I-insulin and of activation and deactivation of 3-O-methylglucose transport were determined in isolated rat fat cells. Equilibrium bound insulin (7.5, 25, 100 microunits/ml) dissociated with a t1/2 of 2 min (100 microunits/ml), 4 min (25 microunits/ml), and 16 min (7.5 microunits/ml). Consecutive deactivation of transport is observed only in the presence of glucose (1 mM); the t1/2 of deactivation is approximately 60 min (100 and 25 microunits/ml) and 20 min (7.5 microunits/ml). At 15 degrees C, the t1/2 of dissociation (7.5 microunits/ml) is 25 min, and deactivation is not observed. Addition of dithioerythritol (5 mM) during the association of insulin decreased the binding rapidly; however, a reduced insulin effect was only seen if the binding decreased during the early activation phase of transport. In conclusion, the maintenance of the insulin effect on transport does not require persistent receptor occupancy; dissociation and deactivation are, with respect to kinetics, temperature dependency and requirement of glucose, independent processes. Receptor occupancy probably only controls the activation of transport; deactivation seems to be controlled by postreceptor processes.

3-O-Methylglucose↗
PubMed1981

Coupling of insulin binding and insulin action on glucose transport in fat cells.

The initial lag phase of insulin action on glucose transport in adipocytes reflects an unknown process that couples receptor binding and glucose transport activity. The influence of temperature, cellular ATP, cyclic AMP, and calcium on this process and a possible relation to internalization of insulin were studied. The Arrhenius plot of the coupling shows a break in slope at 30 degrees C; the activation energy below 30 degrees C is 17.5 kcal/mol. Reduction of cellular ATP by 70% prolongs the coupling process; initial binding and final maximal response of the glucose transport remain unaffected. Further reduction of ATP (greater than 90%) before addition of insulin abolishes the coupling completely. Reduction of ATP at different time points after addition of insulin blocks further activation; however, the actual state of activity is preserved. Calcium depletion by EDTA prolongs the coupling and decreases the maximal response. Internalization of insulin as determined in chloroquine-treated cells begins later than transport activation and is in contrast to transport activation not observable at 15 degrees C. In conclusion, the coupling is not related to internalization; it is ATP-dependent, whereas the initial binding and the activated transport system are ATP-independent. Calcium but not cyclic AMP might be second messenger or cofactor in the coupling process.

3-O-Methylglucose↗
PubMedDate not supplied

DIABLOG: a simulation program of insulin-glucose dynamics for education of diabetics.

This paper presents a dialogue computer program, DIABLOG, for the education of diabetic patients with insulin therapy. Through mathematical modelling of glucose-insulin dynamics this program is able to simulate glucose and insulin profiles of a 24 h period and display them graphically as curves. The subjects could vary the carbohydrate content of meals, the injection time and dose of short-acting and intermediate-acting insulin and could switch to insulin pump therapy. For a first evaluation 22 patients with insulin-dependent diabetes mellitus tested the program and their comments were recorded by a questionnaire. The results indicate a good acceptance of the program even by patients with no previous computer experience. Further suggestions by the patients will be discussed as well.

Blood Glucose↗