[Fractures of vital teeth under chronic pain therapy with oxycodone].
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Aged↗
Biomedical subjects
H Berthold
Publications and source records attributed to H Berthold.
Supporting family carers through the use of information and communication technology--the EU project ACTION.
Assisting Carers Using Telematics Interventions to meet Older persons' Needs (ACTION) is an EU project designed to improve the quality of life of frail older and disabled people and their family carers by the use of information and communication technology. It involved Sweden, England, Northern Ireland, the Republic of Ireland and Portugal. This article provides an overview of the research and development process of the ACTION system and services. The focus is upon the evaluation results with regard to the quality of life of older people and their family carers, the usability of ACTION and cost considerations. Recommendations are made regarding user-focused technology such as ACTION.
Aged↗
Calcium influx into dendrites of the leech Retzius neuron evoked by 5-hydroxytryptamine.
5-Hydroxytryptamine (5-HT) is a ubiquitous neurotransmitter and neuromodulator that affects neural circuits and behaviours in vertebrates and invertebrates. In the present study, we have investigated 5-HT-induced Ca(2+) transients in subcellular compartments of Retzius neurons in the leech central nervous system using confocal laser scanning microscopy, and studied the effect of 5-HT on the electrical coupling between the Retzius neurons. Bath application of 5-HT (50mM) induced a Ca(2+) transient in axon, dendrites and cell body of the Retzius neuron. This Ca(2+) transient was significantly faster and larger in dendrites than in axon and cell body, and was half-maximal at a 5-HT concentration of 5-12mM. The Ca(2+) transient was suppressed in the absence of extracellular Ca(2+) and by methysergide (100mM), a non-specific antagonist of metabotropic 5-HT receptors, and was strongly reduced by bath application of the Ca(2+) channel blocker Co(2+) (2mM). Injection of the non-hydrolysable GTP analogue GTPgammaS increased and prolonged the dendritic 5-HT-induced Ca(2+) transient. The non-selective protein kinase inhibitor H7 (100mM) and the adenylate cyclase inhibitor SQ22536 (500 mM) did not affect the Ca(2+) transient, and the membrane-permeable cAMP analogue dibutyryl-cAMP (500 mM) did not mimic the effect of 5-HT application. 5-HT reduced the apparent electrical coupling between the two Retzius neurons, whereas suppression of the Ca(2+) influx by removal of external Ca(2+) improved the transmission of action potentials at the electrical synapses which are located between the dendrites of the adjacent Retzius neurons. The results indicate that 5-HT induces a Ca(2+) influx through calcium channels located primarily in the dendrites, and presumably activated by a G protein-coupled 5-HT receptor. The dendritic Ca(2+) increase appears to modulate the excitability of, and the synchronization between, the two Retzius neurons.
Animals↗
A retrospective classification of tooth injuries using a new scoring system.
The WHO classification presently in use categories dental trauma only according to the main injury. A new scoring system will now enable more precise and complete diagnosis of tooth injuries. In an initial retrospective investigation, 100 traumatised teeth were classified according to the WHO and the new scoring systems. Clinical and radiological examinations and another evaluations using the new scoring system were made at the time of follow-up examination. Avulsion, intrusion, and root fractures (score < 30) showed the most unfavourable findings at the time of the accident. In comparison, the most favourable findings were shown by concussion and first degree crown fracture (score > 70). A comparison to the WHO classification occasionally revealed noticeable score variations within a single WHO type of injury. Generally, a strong interdependence was observed between the evaluations at the time of the accident and at the time of the follow-up examination (P < 0.001). If the score at the time of the accident was equal to or larger than 57, a successful therapy was usually ensured (P < 0.001). The new scoring system enables more complete diagnosis as well as permitting statements to be made concerning prognosis.
Chi-Square Distribution↗
Ethical dimensions of supervision: the supervisors' experiences.
Group-orientated supervision is provided continually to student nurses during their education. In the supervision process it is necessary to create a relationship between the supervisor and the supervisee that is based on an ethical, trusting relationship. The aim of the study was to investigate supervisors' (n = 18) experiences of the ethical dimensions of ongoing group-orientated supervision. An additional aim was to describe the supervisors' values by which they are guided in supervision. Data were collected by means of an open-ended questionnaire and analysed using the hermeneutic transformative process. The findings revealed the following themes: respect and responsibility; carefulness and sensitivity; reflection and confirmation; and genuineness and fairness. The values guiding the supervisors were dignity, normative ethics, privacy and confidentiality.
Education, Nursing, Baccalaureate↗
Rupture of an angioplasty balloon after treatment of a recurrent in-stent restenosis-lesion of the left anterior descending coronary artery with directional coronary atherectomy.
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Aged↗
Quantification of conversion and degradation of circulating angiotensin in rats.
The aim of the present study was to quantify with a uniform technique the rates of conversion of ANG I to ANG II in the lung and kidney and the degradation of both peptides to biologically inactive products in the pulmonary, renal, and systemic circulation. We infused the peptides intravenously, into the left ventricle, and into the left renal artery of rats and compared their effects on renal blood flow. The measured change in renal blood flow was used as a bioassay parameter to estimate the concentration of circulating ANG II. Mathematical analysis of our data allowed us to calculate conversion and degradation rates. Furthermore, the role of aminopeptidases A (EC 3.4.11.7) and N (EC 3.4.11.2) in the degradation of the peptides in the kidney was investigated by intrarenal infusion of the inhibitor amastatin. Our results show that the conversion rate of ANG I is 75% in the pulmonary and 21% in the renal circulation. Both peptides are degraded by 5% in the pulmonary, by 67% in the systemic, and by 93% in the renal circulation. Amastatin prevented 60% of the renal degradation of the peptides to inactive products, and this effect could be attributed to inhibition of aminopeptidase N. The results indicate that the converting capacity of the kidney is of minor importance for endocrine generation of ANG II but could be useful for the paracrine production.
Aminopeptidases↗
Contribution of endothelin to renal vascular tone and autoregulation in the conscious dog.
Exogenous endothelin-1 (ET-1) is a strong vasoconstrictor in the canine kidney and causes a decrease in renal blood flow (RBF) by stimulating the ETA receptor subtype. The aim of the present study was to investigate the role of endogenously generated ET-1 in renal hemodynamics under physiological conditions. In six conscious foxhounds, the time course of the effects of the selective ETA receptor antagonist LU-135252 (10 mg/kg iv) on mean arterial blood pressure (MAP), heart rate (HR), RBF, and glomerular filtration rate (GFR), as well as its effects on renal autoregulation, were examined. LU-135252 increased RBF by 20% (from 270 +/- 21 to 323 +/- 41 ml/min, P < 0.05) and HR from 76 +/- 5 to 97 +/- 8 beats/min (P < 0. 05), but did not alter MAP, GFR, or autoregulation of RBF and GFR. Since a number of interactions between ET-1 and the renin-angiotensin system have been reported previously, experiments were repeated during angiotensin converting enzyme (ACE) inhibition by trandolaprilat (2 mg/kg iv). When ETA receptor blockade was combined with ACE inhibition, which by itself had no effects on renal hemodynamics, marked changes were observed: MAP decreased from 91 +/- 4 to 80 +/- 5 mmHg (P < 0.05), HR increased from 85 +/- 5 to 102 +/- 11 beats/min (P < 0.05), and RBF increased from 278 +/- 23 to 412 +/- 45 ml/min (P < 0.05). Despite a pronounced decrease in renal vascular resistance over the entire pressure range investigated (40-100 mmHg), the capacity of the kidneys to autoregulate RBF was not impaired. The GFR remained completely unaffected at all pressure levels. These results demonstrate that endogenously generated ET-1 contributes significantly to renal vascular tone but does not interfere with the mechanisms of renal autoregulation. If ETA receptors are blocked, then the vasoconstrictor effects of ET-1 in the kidney are compensated for to a large extent by an augmented influence of ANG II. Thus ET-1 and ANG II appear to constitute a major interrelated vasoconstrictor system in the control of RBF.
Angiotensin-Converting Enzyme Inhibitors↗
Stimulation of the renin-angiotensin system by endothelin subtype A receptor blockade in conscious dogs.
Previous studies in dogs have shown additive or even synergistic effects of combined angiotensin-converting enzyme inhibition and either nonselective endothelin subtype A/B (ETA/B) or selective endothelin subtype A (ETA) receptor blockade on renal vascular resistance and mean arterial blood pressure. A possible mechanism underlying this interaction may be a stimulation of the renin-angiotensin system during endothelin (ET) receptor blockade. We therefore investigated whether plasma renin activity and renin release are regulated by the ETA receptor. Experiments were made in conscious, chronically instrumented dogs receiving either saline or the selective ETA receptor antagonist LU 135252 (10 mg/kg IV). Eighty to 100 minutes after the administration of LU 135252 (n=5), heart rate (99+/-7 versus 81+/-6 bpm; P<0.05) and renal blood flow (327+/-40 versus 278+/-36 mL/min; P<0.05) were increased significantly, whereas mean arterial blood pressure tended to be lower (93+/-5 versus 105+/-7 mm Hg). These changes were associated with a 2-fold increase in plasma renin activity (0.74+/-0.12 versus 0.37+/-0.10 ng angiotensin I per milliliter per hour; P<0.05). Measurements of renin release at various renal perfusion pressures (n=5) with the use of a vascular occluder implanted around the left renal artery revealed that ETA receptor blockade did not alter renin release at resting renal perfusion pressure (78+/-25 versus 71+/-39 U/min) but strongly enhanced the sensitivity of pressure-dependent renin release <80 mm Hg approximately 2.2-fold. In conclusion, selective ETA receptor blockade is associated with a stimulation of the circulating renin-angiotensin system, which results from both a sensitization of pressure-dependent renin release and a larger proportion of blood pressure values falling into the low pressure range, where renin release is stimulated. These find-ings strengthen the view that ET and the renin-angiotensin system closely interact to regulate vascular resistance and provide a physiological basis for synergistic hypotensive effects of a combined blockade of both pressor systems.
Animals↗
Interaction between nitric oxide and endogenous vasoconstrictors in control of renal blood flow.
The level of renal blood flow (RBF) is controlled by opposing vasoconstrictor and vasodilator influences. In a recent investigation in normotensive dogs, we found that combined blockade of endothelin type A (ET(A)) receptors and angiotensin II formation induces marked increases in RBF that were much larger than the effects of blocking either system alone. The aim of the present study was to determine the contribution of nitric oxide (NO) to this vasodilator response. Experiments were made in 6 conscious, chronically instrumented dogs subjected to 5 different experimental treatments on separate days. Blockade of ET(A) receptors alone by the selective antagonist LU 135252 had only minor effects on RBF compared with time-control experiments. Additional blockade of angiotensin II formation by angiotensin-converting enzyme inhibition with trandolaprilat caused a substantial increase of RBF by approximately 50%. This vasodilation was entirely suppressed when NO formation was prevented by inhibition of NO synthase with N(G)-nitro-L-arginine methyl ester HCl. However, when during NO synthase inhibition renal vascular NO concentrations were clamped at control levels by infusing the NO donor S-nitroso-N-acetyl-D, L-penicillamine, the vasodilator response to combined blockade of ET(A) receptors and angiotensin II formation was completely restored (DeltaRBF approximately 60%). These results indicate that the vasodilation after combined ET(A) receptor blockade and angiotensin-converting enzyme inhibition is not mediated by an increase in NO release but results from the unmasking of the tonic influence that is normally exerted by constitutively released NO. Accordingly, the tonic activity of endothelial NO synthase appears to be of major importance in the physiological regulation of renal vascular resistance by determining the vasomotor responses to endothelin and angiotensin II.
Angiotensin II↗
Renal haemodynamic responses to exogenous and endogenous adenosine in conscious dogs.
1. Adenosine has been suggested to be the mediator of a metabolic feedback mechanism which transfers acute changes in the tubular load into opposite changes in renal blood flow (RBF). The goal of the present experiments was to assess the importance of endogenously formed adenosine as a 'homeostatic metabolite' during short-term changes in metabolic demand. 2. In nine chronically instrumented conscious foxhounds, both the direct effects of adenosine injections (10, 30 and 100 nmol) into the renal artery and the temporal changes of RBF after short renal artery occlusions (15, 30 and 60 s duration), the most widely used experimental model to study the metabolic feedback mechanism in vivo, were studied. 3. Intrarenal bolus injections of adenosine (10, 30 and 100 nmol) induced dose-dependent decreases of RBF (RBF: -34 +/- 5, -59 +/- 4 and -74 +/- 4 %, respectively). This vasoconstrictor effect of adenosine was significantly larger (RBF: -51 +/- 4, -68 +/- 4 and -83 +/- 3 %, respectively) when the dogs received a low salt diet. 4. The post-occlusive responses were characterized by a transient hyperaemia with no detectable drop of RBF below the preocclusion level. The post-occlusive responses were affected neither by changes in local angiotensin II levels, nor by intrarenal infusions of hypertonic NaCl or blockade of A1 adenosine receptors. 5. When intrarenal adenosine levels were elevated by infusion of the adenosine uptake inhibitor dipyridamole, a transient, although weak, post-occlusive vasoconstriction was detected. 6. In summary, the present data demonstrate that adenosine acts as a potent renal vasoconstrictor in the conscious dog. The endogenous production of adenosine during short-lasting occlusions of the renal artery, however, appears to be too small to induce a post-occlusive vasoconstrictor response of RBF. These results suggest that a metabolic feedback with adenosine as 'homeostatic metabolite' is of minor importance in the short-term regulation of RBF in the conscious, unstressed animal.
Adenosine↗
A clinical and virological study of hepatitis C virus-related cryoglobulinemia in Germany.
BACKGROUND/AIMS: Several reports, especially from Southern Europe, have demonstrated a close association between hepatitis C virus (HCV) infection and mixed cryoglobulinemia. In this study we have analyzed the significance of HCV-related cryoglobulinemia in Germany. METHODS: Sera from 79 patients with cryoglobulinemia of type I (n=21), II (n=28) or III (n=30) were investigated for HCV markers. Furthermore, 132 consecutive patients with chronic hepatitis C were studied for the presence of cryoglobulins. Genotypes of HCV were determined according to Simmonds, and HCV-RNA concentrations were measured in patients with and without cryoglobulinemia. RESULTS: In 79 patients with cryoglobulinemia we found anti-HCV antibodies in 17 (22%) and HCV-RNA in 11 patients (14%). HCV antibodies were more frequent in essential (44%) compared to secondary mixed cryoglobulinemia (15%). In 132 patients with chronic HCV infection cryoglobulins were detected in 37 patients (28%), in 21 of them at low levels. Clinical symptoms due to cryoglobulinemia were observed in eight of the 37 patients, severe vasculitis in three patients with high cryocrit-levels and cryoprecipitation at room temperature. HCV genotype 1 and subtype 1b were most prevalent, both in patients with and without cryoglobulinemia, and mean HCV-RNA levels were not different between the two groups. Comparison of HCV-RNA levels in cryoprecipitates, supernatant and native serum suggests binding of HCV-RNA to the cryoprecipitate with different affinity in individual patients. CONCLUSIONS: The lower prevalence of HCV-related cryoglobulinemia in our study compared with data from Italy and France suggests a south-north gradient in the prevalence of HCV-associated cryoglobulinemia in Europe.
Adult↗
A comparison of the incidence of breast feeding two and four months after delivery in mothers discharged within 72 hours and after 72 hours post delivery.
OBJECTIVE: To compare breast feeding at two and four months after delivery in mothers discharged early (ED = before 72 hours post delivery) and late (LD = after 72 hours post delivery), and to explore the factors of greatest importance to the successful practice of breast feeding. DESIGN: Ex-post facto design. SETTING: In the country of Härryda, Sweden. PARTICIPANTS: All Swedish speaking women in the country of Härryda whose babies were born between 01.01.94 and 31.05.94 and who were registered at the Child Health Station (CHS) by the age of three months. One hundred and ninety women were invited to participate and 157 (83%) accepted. MEASUREMENTS AND FINDINGS: No significant difference was found in the breast feeding rates between the ED and LD group. However, ED mothers breast fed exclusively to a higher extent at two and at four months (exclusive breast feeding: at two months 89% and 86% respectively, and at four months 84% and 74% respectively, partial breast feeding: at two months 6% and 10% respectively, and at four months 5% and 12% respectively). If the woman considered that she had received encouragement and support while breast feeding for the first time, the probability of her breast feeding at two and at four months were about six times as great (Exp(B) 5.7594, df = 1, p = 0.0270; (Exp(B) 5.9781 df = 1, p = 0.0005 respectively). KEY CONCLUSIONS: The length of the hospital stay had no significant effect on the incidence of breast feeding at two and four months post delivery. The most predominant factors influencing breast feeding were seen to be the mother's first experience of breast feeding and the degree of support, help and encouragement she received. Less than half of the women received a visit from the CHS nurse after their return home from hospital. IMPLICATIONS FOR PRACTICE: The findings suggest that it is important that the midwife or nurse should prepare, support and encourage the mother when breast feeding for the first time. The midwife's or nurse's interventions are important for the incidence of breast feeding, at least during the first four months, and indirectly affect public health. This must also be taken into consideration when caring for mothers in the delivery ward and before discharge, i.e. that the breast feeding is working well, that the mother experiences it as working well, and also for planning follow-up after discharge.
Adolescent↗
Catheter-related infections in long-term catheterized dogs. Observations on pathogenesis, diagnostic methods, and antibiotic lock technique.
BACKGROUND: Intravascular catheters are associated with severe infections in patients, but only few reports on this problem in animal research exist. OBJECTIVE: We report on catheter-related bacterial colonization and its consequences in long-term catheterized animals. MATERIAL AND METHOD: Foxhounds were instrumented with intravascular catheters and flow probes to study the regulation of renal blood flow and pressures. RESULTS: After flushing the catheters, alterations in renal blood flow were observed and these could be related to bacterial colonization of intravascular catheters with Pseudomonas species. After attention had been focused on aseptic technique in all experimental phases and prophylactic antibiotic lock instituted, the occurrence of Pseudomonas bacteremia ceased, and the magnitude and incidence of catheter-related colonization and infection by Pseudomonas species dropped considerably. CONCLUSION: The catheter-related colonization that occurred spontaneously in these animals resembled findings in animal experiments in which catheter-related infections were deliberately induced as well as observations made with regard to catheter-related infections in patients. This report emphasizes the importance of asepsis when working with animals with long-term intravascular catheters. We suggest that monitoring for this complication, e.g., by means of catheter cultures at the time of removal, should routinely be part of protocols for animal experiments using long-term intravascular catheters.
Animals↗
ACTION. Assisting Carers using Telematics Interventions to meet Older person's Needs.
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Aged↗
Occurrence and management of hepatitis B virus reactivation following kidney transplantation.
A 28-year-old woman was kidney transplanted. She had an inapparent hepatitis B virus (HBV) infection 2 years previously. At the time of transplantation she was hepatitis B surface antigen (HBsAg) negative, anti-HBs, anti-HBc, anti-HBe and anti-HCV antibody positive and her transaminase activities were within the normal range. The donor of the kidney allograft was HBV negative. Twelve weeks after transplantation a life-threatening liver failure occurred with a rapid rise of alanine aminotransferase (ALT) to 1427 U/l and a decrease of the prothrombin time to 25% of normal value. Anti-HBs had become negative, anti-HBc and anti-HBe titers had decreased. HBsAg became positive, associated with a HBV DNA of 3 x 10(8) genome equivalents/ml. Azathioprine and prednisone were withdrawn and foscarnet therapy was started. This therapy led to a decrease of ALT activity associated with an elimination of HBsAg and HBV DNA. Eight months after transplantation liver function tests were within the normal range. Graft rejection did not occur despite low or intermittent cessation of immunosuppressive therapy.
Adult↗
[Current hepatitis B epidemiology in Germany].
Hepatitis B (HB) is the most common occupational hazard for health care workers. On the other hand 90% of the notified HB cases in Germany are observed among the general population (including other high-risk groups like i.v. drug abusers etc.). About 350 million persons all over the world are carriers of the hepatitis B virus (HBV). The availability of effective HB vaccines since 1982 made a control of HB possible. In this communication we report on epidemiological changes due to hepatitis B vaccination in a large university hospital in Germany. Health care workers and non-health care workers occupied at Freiburg university hospital were tested for HBV markers in 1984/85 (n = 4218), 1989/90 (n = 4081) and 1994/95 (n = 4022) during routine occupational health check-ups. Vaccinations were performed using a plasma-derived vaccine (1984/85) or a vaccine obtained by genetic engineering, respectively (1989/90, 1994/95). In 1984/85 prevalence of anti-HBs/HBc in German health care workers (12.4%) was 2.5 times higher than the one in non-health care workers (4.9%), in 1994/95 anti-HBs/HBc prevalence in both groups (4.4 vs. 4.5%) was comparable. On the other hand HBV carriage in persons occupied in professions without blood contact increased from 1984/85 (0.5%) to 1994/95 (1.1%). Therefore, the number of HBV carriers (ca. 1.1 millions) in Germany can be roughly estimated. Our data indicate a high degree of effectiveness of hepatitis B vaccines. Vaccination programme for the general population in accordance with German (STIKO) and WHO recommendations are necessary for the control of HBV infection.
Carrier State↗
Mandibular fractures following third molar extraction. A retrospective clinical and radiological study.
Twelve patients with 13 mandibular fractures following third molar extraction were treated in our Department between 1980 and 1995. Clinical and radiographic data relating to these patients were analysed retrospectively to determine complication characteristics. Only one fracture occurred during surgery. The first week after the operation was found to be most critical for fracture occurrence. A "cracking" sound from the jaw while eating frequently indicated that a fracture had occurred, but repeated radiographic examination may be necessary for definitive diagnosis. Most teeth removed belonged to Groups II/III according to PELL & GREGORY's classification, indicating partial or total impaction of the tooth and a narrow space in the retromolar triangle. In all cases, tooth roots were superimposed on or adjacent to the inferior alveolar canal. Clinically, the age of the patient seemed to be a common predisposing factor, and patients older than 30 to 40 years were considered to be a risk group. Regardless of the degree of impaction and tooth position, the fracture type seen was uniform, i.e. preangular location and a typical course of the fracture line. After adequate fracture treatment, no further complications were noted.
Adult↗