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H Becker

Publications and source records attributed to H Becker.

At least 163 records · Page 9Linked to original sources
PubMed1995

[Errors and risks in administration of nasal respiratory therapy of obstructive sleep apnea].

Over a period of 1 year we observed in our sleep laboratory in 502 patients with sleep related breathing disorders several side effects of positive airway pressure treatment, furthermore we observed in 5 patients unexpected dangerous complications due to the application of CPAP and BIPAP. We observed mask leakages which lead to insufficient positive airway pressure-therapy and an occurence of short central apnoeas during NREM sleep after arousal or wakefulness periods. Finally we observed in 5 patients during treatment with CPAP and BIPAP an unexpected appearance of long central apnoeas up to 110s and central hypoventilations up to 5 min accompanied by excessive hypoxaemia (SaO2 < 20%) and cardiac arrhythmias. We conclude that in the treatment of obstructive sleep apnoeas we have to expect in 1-2% complications of the positive airway pressure treatment itself. To avoid life endangered complications the first night application should be done only in conventional sleep laboratories.

Equipment Failure↗
PubMed1995

[Parameters for determining the effective treatment pressure in nCPAP therapy of sleep apnea].

We evaluated the accuracy of single parameters from the polysomnography in establishing the effective nCPAP treatment pressure in order to possibly economize pressure adjustment. In four patients (pts) a standard polysomnography was performed. 67 segments of 30-60s in duration, showing different typical types of breathing disturbances or normal breathing were selected. The segments were divided into 5 horizontal parts consisting of only one of the following signals: SaO2, snoring, mask pressure, esophageal pressure (Poes) and respiratory movements (RC + Abd). A second investigator then classified these 335 one lead recordings without knowing the complete segment. The classification based on the complete segment compared to that based on only one parameter gave an identical result in 44.8% (SaO2), 61.2% (Poes), 64.2% (RC + Abd), 80.6% (sonoring) and 82.1% (mask pressure) respectively. 97% of the complete segments were classified identically by both investigators. Each of the studied parameters alone was not adequate in establishing the correct pressure level. SaO2 corresponds least, mask pressure and snoring best to the classification based on all parameters.

Air Pressure↗
PubMed1995

[Machine-assisted detection of individually effective minimal CPAP pressure using the Vitalog HMS 5000 monitor].

UNLABELLED: Continuous positive airway pressure ventilation (CPAP) has been proven to be highly effective in the elimination of sleep-related breathing disorders (SRBD) in the last couple of years. The titration of the effective airway pressure should be carried out under continuous polysomnographic supervision in the sleep laboratory. The CPAP ventilation may result in potential hazards through the positive airway pressure and each patient needs an individually adjusted pressure for therapy. In a prospective study we investigated under polysomnographic supervision the effectivity and the hazards of a machine-controlled CPAP calibration in 22 male patients (pts) (age: 53.6 +/- 8.9 years, BMI: 29.9 +/- 5.0 kg/m2) with obstructive SRBD (RDI: 50.6 +/- 1/h). Automatic CPAP-calibrations were carried out using the Vitalog HMS-5000 monitor and the Respironics BiPAP-STD ventilator. An algorithm determined the cyclical changes of the airway pressure. The following night we controlled the assessed pressure through manual adjustment during conventional polysomnography. RESULTS: The CPAP-levels assessed through the automatic calibrations (8.36 +/- 2.36 cmH2O) showed in 19 pts a good agreement with the CPAP-levels of the control nights (8.15 +/- 2.36 cmH2O), the difference was statistically nonsignificant (p < 0.5). The CPAP-levels of the automatic titrations and the control nights agreed exactly in 12 pts (63%). 3 pts of the 22 failed the automatic CPAP-titration process because of functional or psychical reasons. 14 pts (64% of 22 pts) showed a good functional tolerance to the cyclical changes of the airway pressure. 3 pts were unable to fall asleep under the increasing airway pressure, but after falling asleep at a constant pressure of 2 or 4 cmH2O they could tolerate the automatic pressure titration. A reset of the actual pressure to the baseline was necessary in 13 pts to enable them falling asleep, in 2 pts because of increase of the airway pressure due to movement artifacts, in 2 pts because of central apneas and in one patient because of ventricular extrasystoles. 35 increases of the baseline level (48% of altogether 73 increases) occurred due to clinically irrelevant desaturations. We found a direct hazardous effect of the machine-controlled CPAP-titration (central apneas, secondary alveolar hypoventilation, ventricular extrasystole) in 7 pts with chronic obstructive pulmonary disease and/or cardiovascular disorder. CONCLUSION: The machine-controlled CPAP-titration should be carried out only in a selected group of patients. Nevertheless, despite of the good agreement of the assessed pressure levels with the polysomnographic controls, this method seems to be not suitable for the clinical routine because of its potential hazards and contraindications in high risk patients.

Adult↗
PubMed1995

[Continuous single layer anastomosis as the standard procedure in the gastrointestinal tract].

The continuous suture by single layer technique is suitable for all anastomoses in the gastrointestinal tract. Anastomotic dehiscence rate has been examined and amounts 1.7% for anastomoses in the stomach 0.3% in the small intestine and 2.8% in the colon. In comparison with other techniques the anastomosis is safe and easy to learn. Costs and time of surgery can be reduced significantly.

Anastomosis, Surgical↗
PubMed1995

Transhiatal oesophagectomy compared with transthoracic resection and systematic lymphadenectomy for the treatment of oesophageal cancer.

OBJECTIVE: To compare the results of transhiatal oesophagectomy with those of transthoracic resection with systematic two field en bloc lymphadenectomy in the treatment of carcinoma of the oesophagus. DESIGN: Prospective open (non-random) study. SETTING: University hospital, Germany. SUBJECTS: 87 patients with carcinoma of the oesophagus of whom 46 underwent transhiatal, and 41 transthoracic resection. MAIN OUTCOME MEASURES: Morbidity and short and long term mortality. RESULTS: The type of operation was chosen on clinical grounds, and the groups were comparable except for site and type of tumour, and nodal stage. The hospital mortality was 7/46 (15%) in the transhiatal group and 4/41 (10%) in the transthoracic group. The most common complication was anastomotic leak (23/46, 50%, compared with 10/41, 24%, p = 0.014), followed by major pulmonary complications (16/46, 35%, compared with 12/41, 29%), and cardiac complications (12/46, 26% compared with 11/41, 27%). Median survival was 350 days in the transhiatal group and 378 days in the transthoracic group. The percentage survival after one, two, and three years in the two groups was 48 and 55, 26 and 18, and 21 and 17, respectively. There were no significant differences in short or long term mortality. CONCLUSION: We have been unable to show that the oncologically more radical procedure (transthoracic resection with systematic two field en bloc lymphadenectomy) results in longer survival, but we have shown that it can be done with similar morbidity and short term mortality. Because it is possible to stage the disease exactly with a transthoracic resection, and because published reports from other centres have hinted at improved prognosis after it, we shall continue to do the operation for suitable patients.

Adult↗
PubMed1994

[The most frequent depressive disorders. Diagnosis, classification, symptoms and prognosis].

The most frequent depressive disorders--anxiety and panic syndrome, dysthymic (neurotic) illnesses and reactive depressive adjustment disorders--were classified according to the new international codes. It was also explained that theoretical aetiological assessment principles had to be replaced by duration and symptomatology as operational criteria. Further, a table was elaborated for diagnosing depressive syndromes from an intrapsychic, social and somatic standpoint. Epidemiological aspects of both German and international studies were discussed and prognostic factors highlighted.

Cross-Sectional Studies↗
PubMed1994

[Effect of resection or duct drainage on glucose stimulated beta cell function in chronic pancreatitis].

Chronic pancreatitis (CP) leads to deterioration of the endocrine pancreatic function by fibrotic destruction. The aim of the present study was to investigate whether resection or duct drainage in patients with CP would have a direct impact on the pancreatic beta cell function. An intravenous glucose tolerance test (IVGTT) was performed before, after and in some cases 3 months after operation in ten patients each of whom had been treated by either resection or duct drainage. Three patients undergoing pancreatic resection for cancer served as controls. Beta cell function was assessed by glucose elimination (K-values), insulin and C-peptide response. K-Values in patients with CP were not significantly influenced after resection (1.93 +/- 0.78/2.13 +/- 0.72; n.s.) or drainage (1.26 +/- 0.47/1.54 +/- 0.58; n.s.) but reduced in all three tumor patients (2.23 +/- 0.55/1.23 +/- 0.43). The initial insulin response [microU/ml] in CP patients was also not altered after resection (19.7 +/- 17.3/16.0 +/- 18.2; n.s.) or after drainage (16.7 +/- 16.5/13.0 +/- 9.0; n.s.), whereas all three resected tumor patients showed reduced values (42.9 +/- 15.7/17.5 +/- 3.8). Stimulated C-peptide synthesis [ngmin/ml] was not substantially lowered in patients resected for CP (90.5 +/- 85.6/73.8 +/- 48.9; n.s.) or in the drainage group (121.3 +/- 67.5/98.0 +/- 57.2; n.s.), but this parameter was decreased in every tumor patient postoperatively (157.8 +/- 66.9/125.1 +/- 69.6). Resection in patients with chronic pancreatitis did not inevitably result in loss of beta cell function. Parenchyma-preserving drainage procedures had no measurable advantage in this respect.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗
PubMed1994

Patterns of skull base fracture: a three-dimensional computed tomographic study.

Three-dimensional (3D) computed tomographic (CT) reconstructions were studied retrospectively in 14 patients with skull base fractures. Our aim was to assess the clarity of visualisation and pattern of these fractures. The reformations were obtained from 3 mm thick two-dimensional (2D) CT images. The 2D data stored on optical discs were retrieved and reformatted using the scanner's software. The 3D technique could demonstrate the presence of fractures as well as 2D images. It was of special value in defining the depth and extent of fractures in the floor of the cranial fossae. Undisplaced and displaced fractures could both be demonstrated. Fractures in the anterior fossa run diagonally towards the midline and then cross the cribriform plate of the ethmoid bone. Fractures of the middle fossa run obliquely anteroposterior. Fractures in the lamina papyracea and cribriform plate were difficult to reconstruct due to the thinness of these bones and threshold definitions. The volume of the 3D block determines the angles suitable for viewing the fractures. In spite of present technical difficulties, the 3D images are of greater anatomical and diagnostic value, particularly in anterior fossa fractures. There is no additional radiation risk to the patient, since reconstructions are made from routine 2D images.

Adolescent↗
PubMed1994

Bacillus cereus in infant foods and dried milk products.

Dried milk products and infant food are known to be frequently contaminated with Bacillus cereus. Sources of the organism and its behaviour in the product and in the equipment during processing are discussed. With regard to the incidence of B. cereus in infant food, 261 samples distributed in 17 countries were collected and examined for its B. cereus content. Fifty-four percent of the samples were contaminated with B. cereus reaching levels from 0.3 to 600/g. Counts higher than 10/g were found in only 27 samples (10%). Most of the positive samples (44%) contained 0.3 to 10 B. cereus/g. Four samples (1.5%) were contaminated with more than 100 organisms/g reaching a maximum level of 600 B. cereus/g. When classified into different types of products about 50% of the infant formulae based on milk, the follow-on formulae and the weaning foods were contaminated with B. cereus as well as 69% of those based on soy protein and 92% of the special dietetic foods. Compared to our earlier studies from 1982/83, the percentage of contaminated samples from Germany increased from 31% to 70% in the case of infant formulae, from 28% to 55% in the case of follow-on formulae, and from 40% to 100% in the case of special dietetic food. The percentage of weaning food contaminated with B. cereus remained nearly unchanged. It should be stressed, however, that the numbers of B. cereus were almost the same in both studies with the highest count in 1982/83 being 460 and in 1992 600/g. Samples naturally contaminated with counts of about 100 B. cereus/g were reconstituted and incubated at a room temperature of 27 degrees C. Levels of 10(5) B. cereus/g were reached after 7-9 h. Toxigenicity of B. cereus in dried milk products and infant food as well as food poisoning outbreaks attributed to B. cereus are discussed.

Animals↗
PubMed1994

Bioactive chromenes from Rhyncholacis penicillata.

Investigation of the aerial parts of Rhyncholacis penicillata afforded the new chromenes, 7-hydroxy-6-(3-methylbutyryl)-5-oxymethyl-chromene (rhynchonin A) and 7-hydroxy-6-(2-methylbutyryl)-6-oxymethylchromene (rhynchonin B). Structures were elucidated by spectroscopic methods and independent synthesis. Rhynchonin A showed broad insecticidal, acaricidal and nematicidal potency including strong biological activity against Heliothis zea.

Animals↗
PubMed1994

The role of triterpenoids in the topical anti-inflammatory activity of Calendula officinalis flowers.

By means of a bioassay-oriented fractionation of the CO2 extract of Calendula flowers, the triterpenoids are shown as the most important anti-inflammatory principles of the drug. Among them, the faradiol monoester appears to be the most relevant principle for the activity of the drug, due to its quantitative prevalence. The unesterified faradiol, not present in the extract, is the most active of the tested compounds and equals indomethacin in activity, whereas the monools psi-taraxasterol, lupeol, taraxasterol, and beta-amyrin are less active than the free diol. The anti-inflammatory activity of different CO2 extracts is proportional to their content of faradiol monoester, which can be taken as a suitable parameter for the quality control of Calendula preparations.

Animals↗
PubMed1994

[Gender identification disorders from the clinical perspective. A contribution from psychiatric practice].

Referring to the recent debate on how to describe and classify "transsexual phenomena" according to psychopathological and diagnostic criteria and the necessary definition of standards of care, this investigation is intended as a clinically oriented contribution to the study of gender identity disorders. Beside a literature review to outline the different theoretical positions, several case reports are presented to illustrate and analyze the variety and complexity of conditions which are underlying or concomitant to the desire for a sex change. This study focuses on the need for more careful diagnostic considerations and scrupulous follow-up of patients presenting with the conviction of wrong sex assignment. Although it seems reasonable to "detotalize" transsexualism, the authors plead for the adherence to a clinically oriented approach to this issue. They disagree with arguments to abandon a "nosomorphic view" or with notions that regard transsexualism as a "minority which has been pathologized". In order to match demands properly and to give adequate advice it appears necessary to improve general knowledge and specific therapeutic competence in the field of gender identity disorders.

Adult↗
PubMed1994

Late intestinal strictures following successful treatment of necrotizing enterocolitis.

Between 1975 and 1992, in 16 infants (14%) out of 113 neonates with previous necrotizing enterocolitis (NEC) a total of 25 intestinal strictures had to be treated. Four (16%) were found in the ileum and 21 (84%) in the colon, and in 50% multiple strictures were present. In these 16 patients initial treatment for acute NEC included conservative treatment in 5, primary resection and enterostomies in 6 and proximal diverting enterostomies in 5. Therefore, the incidence of late strictures was 11% after conservative therapy, 11% after primary resection and 55% after primary proximal diverting enterostomies. An average of 49 days elapses between the recovery from NEC and the diagnosis of late strictures in conservatively treated patients. After initial surgical treatment, late strictures were detected on contrast studies on an average of 80 days. In pathologic specimens, marked fibrosis in the submucosa was consistently present in all strictures, whereas inflammatory changes in the mucosa, disruption or hypertrophy of the muscle layers or absence of ganglion cells were seen less frequently. All strictures were resected and primary end-to-end anastomosis was performed. But despite the development of late intestinal strictures, bowel preservation was improved after initial restrictive surgical therapy and aggressive medical treatment.

Constriction, Pathologic↗