PubMed Health⌕ Search

Biomedical subjects

H Biedermann

Publications and source records attributed to H Biedermann.

At least 19 recordsLinked to original sources
PubMed2006

[Optimizing the nursing process by new management instruments. The Northern Germany Nursing Research Network].

The Northern Germany Nursing Research Network (Pflegeforschungsverbund Nord) has dedicated itself to developing management instruments intended to optimize the nursing process. It is coordinated by the administrative office of the Institute of Public Health and Nursing Research (Institut für Public Health und Pflegeforschung IPP, director: Prof. Dr. Stefan Görres), Department of "Interdisziplinäre Alterns- und Pflegeforschung", University of Bremen. Four partial projects are currently being worked on in two groups: Group A--"Deficient areas of nursing action": The projects belonging to this group are "Individual care-patterns of elderly people and their determinants" (University of Bremen) and "Mobility Restrictions in Nursing Homes-Multicentre Observational Study (MORIN)" (University of Hamburg). The purpose of these studies is to examine the relevance of quantitatively significant risk combinations from a nursing science perspective. Group B--"The generation and testing of nursing action management instruments": The projects in this area are "Nursing rounds as instruments of quality assurance in home-based care" (University of Applied Sciences, Bremen) and "Predicting the risk of falls, efficiency of standard scales in opposition to nursing assessment-Cluster-Randomised Controlled Trial (PROFESSION)" (University of Hamburg). These studies concentrate in a unique manner on the generation and testing of management/control instruments suitable for application to nursing action.

Activities of Daily Living↗
PubMed2002

[The role of perforating vein dissection in the treatment concept of venous ulcers--myths and evidence].

Crural ulcers represent the most serious form of chronic venous incompetence (CVI). According to duplex studies superficial venous incompetence predominate in this stage of the disease, but combined refluxes of superficial and deep veins are also common. Despite a positive correlation between the number of incompetent perforators and the stage of CVI isolated incompetence of perforating veins in venous ulcers are rarely found. Additionally, only a minority of incompetent perforators depict larger reflux volumes. Therefore, doubts about a causal role of perforators incompetence in ulcer genesis are justified. According to phlebodynamometric studies the risk of crural ulcer development increases with the degree of hemodynamic compromise. Ulcer healing can only be achieved after complete normalization of ambulatory venous hypertension. In case of superficial refluxes and concomitant incompetence of perforating veins exclusion of the superficial component is sufficient to achieve this goal. Incompetent perforators normalize their function consecutively. In contrast, venous hypertension persists after exclusion of superficial refluxes in case of incompetent perforators and irreversible damage of the deep venous system. Surgical therapy studies exactly reflect the results of these hemodynamic examinations. Therefore, the role of endoscopic subfascial perforator dissection (ESPD) in the treatment of venous ulcers remains unclear. Future therapy studies should take into account that the definite role of ESPD in ulcer healing can only be examined without additional treatment of refluxes in the saphena system. Additionally, all study patients should be classified according to the CEAP nomenclature and Hach's classification of chronic compartment syndrome. Methodological differences in technique and extent of ESPD have also to be taken into account.

Angioscopy↗
PubMed1999

Thrombolytic therapy in adult meningococcal purpura fulminans with acute renal failure and severe perfusion deficits to the extremities.

OBJECTIVE: To investigate whether systemic administration of recombinant tissue plasminogen activator would improve organ perfusion in an adult patient with fulminant meningococcal disease. DESIGN: Descriptive case report. PATIENT: A 45-year-old female with meningococcal septic shock, purpura fulminans and multiple organ failure who was treated in an eight-bed medical intensive care unit of a University hospital. INTERVENTION: In addition to standard aggressive treatment, on each of three consecutive days the patient received recombinant tissue plasminogen activator infusions at a dose of 20 mg over 4 hrs. RESULTS: Urine output was recorded before, during, and after the recombinant tissue plasminogen activator infusions. In addition, the patient's peripheral perfusion status was documented by clinical assessment. The patient showed a dramatic improvement in urine output, as well as a perceived increase in skin perfusion after recombinant tissue plasminogen activator therapy. The amount of exogenous vasopressor and inotropic support required to maintain the patient's hemodynamic status also rapidly decreased. CONCLUSIONS: In this adult patient, recombinant tissue plasminogen activator therapy resulted in improved organ perfusion similar to that reported for paediatric patients. The findings indicate a need for controlled studies concerning the use of thrombolytics in severe meningococcal disease.

Acute Kidney Injury↗
PubMed1998

High cervical stress and apnoea.

The aim of this study was to investigate vegetative reactions in infants after mechanical irritation of the suboccipital region. The investigation is based on 199 infants who were observed while being treated with a suboccipital impulse (manual therapy). The results revealed vegetative reactions in more than half of all cases (52.8%, n = 105). The frequency of such vegetative reactions observed was at follows: flush 48.7% (n = 97), apnoea 22.1% (n = 44), hyperextension 13% (n = 26), and sweating 7.5% (n = 15). It is pointed out that approximately 25% of all the infants examined reacted by apnoea due to a mechanical irritation of the suboccipital region. This symptom was part of an extensive vegetative reaction. This method of inducing an apnoea has not yet been described; from this it follows that there are close relations to sudden infant death.

Apnea↗
PubMed1996

Two-point discrimination of vibratory perception on the sole of the human foot.

The capability for discrimination of vibratory stimuli of the sole of the foot was tested on 12 subjects (6 men, 6 women). Two vibratory stimuli (sinusoidal impulse: frequency, 200 Hz; amplitude, 0.1 mm; duration, 2 sec) were applied at different sites to the sole of the foot. Subjects were asked whether they detected one or two vibratory sensations. The discrimination threshold was defined as the shortest distance at which two vibrations can be differentiated at repeated trials. In addition, the absolute threshold was measured by one plunger (sinusoidal vibration: frequency, 200 Hz; variable amplitude). The values of the absolute threshold (average value, 1.2 microns) were in accordance with the results of other authors. A decrease of discrimination capability was observed along the longitudinal axis of the foot from distal to proximal parts and was about 15 mm at the big toe and 34 mm at the heel. Discrimination at the medial longitudinal arch was inferior to that at the lateral longitudinal arch. This was also true for inverse vibration in which all subjects showed lower thresholds. No relationship was found with respect to thickness of the skin (measured by ultrasound), side of foot, or gender. Determining factors for vibratory threshold might be the density of the Pacinian corpuscles per cm2 as well as their peripheral and central representation. Anatomical or physical factors (e.g., thickness of the skin, impedance of the deeper tissue) can probably be disregarded.

Adult↗
PubMed1994

[Video-controlled, retroperitoneoscopic, lumbar sympathectomy and sympathicotomy].

Six patients with arterial occlusions of the legs underwent VRLS: a small incision is made in the flank, the retroperitoneum pushed aside with a 1.5-1-balloon catheter, the lumbar sympathicus endoscopically severed and/or partially excised with video assistance. The intervention was successful in all cases. Excised parts of the sympathetic trunk were demonstrated histologically in four cases. One case of severe bleeding from a lumbar artery was stopped endoscopically, and one patient underwent additional open resection of 2 cm of the sympathetic trunk. Postoperative intestinal paralysis lasted a mean of two days, and hospitalization five days. VRLS has several disadvantages for the surgeon, while its lesser strain and earlier rehabilitation are a definite advantage for the patient.

Aged↗
PubMed1993

[A new instrument for extirpation of PTFE vascular prostheses. Initial clinical experiences].

In seven patients in whom a PTFE prosthesis had to be removed (six arteriovenous dialysis shunts in the arm and one femoro-popliteal by-pass), surgery was performed with the aid of a newly developed prosthesis removal device. This device consists of a guide rod that is inserted in the prosthesis while a second, chisel-like extension with a sharp cutting edge is advanced along the exterior of the prosthesis to separate it from the tissue. With this technique, up to 17-cm-long segments were extirpated subcutaneously. The only complication was a lesion of an radial artery in an atypically situated AV shunt. The advantages of the new instrument are that it saves time and conserves tissue and skin.

Adult↗
PubMed1989

[Results of micro(vascular) surgical interventions in vascular-induced disorders of erection].

In 71 patients aged 20 to 65 years who suffered from erectile dysfunction of vascular (mainly arterial and venous) origin, we performed 66 microsurgical vascular reconstructions (12 according to Michal II, 42 using Virag I, 5 using the Hauri modification and 7 according to the author's own method) and 5 operations to reduce venous outflow from the corpora cavernosa. In addition, 6 Virag I redo reconstructions and other secondary interventions in 18 cases were performed as well as (semi-)conservative therapeutic measures were undertaken. Over a mean follow-up period of 35.1 months 46 out of 56 men were again able to have adequate to normal sexual intercourse. The other patients showed only minimal improvement or their condition remained unchanged. No patient's condition was seen to worsen. The main complications were occlusions of the reconstruction and the hypervascularization syndrome of the penis, affecting 13.3% of the arterio-venous anastomoses. This complication, which often occurred many months postoperatively, was always overcome with banding and in some cases by additional venous ligatures so that a functional reconstruction remained in all but one case. In cases of erectile dysfunction of vascular origin, vascular surgery presents the most natural form of therapy and therefore deserves consideration before life-long auto-injection therapy is prescribed for the corpora cavernosa or the implantation of a penis prosthesis is considered. Specific angiological investigation is advisable in all cases in which a four- to six-month course of (semi-)conservative treatment does not bring long-term success.

Adult↗
PubMed1989

[Hypervascularization syndrome of the penis following arterialization of the dorsal penile vein for erectile impotence].

A hypervascularization syndrome following arterialization of the deep dorsal vein of the penis to amend venous erectile impotence is a rare cause of penile ulcers that has not previously been described in the dermatological literature. Arterialization is performed by installing a shunt from the inferior epigastric artery or a venous bypass from the femoral artery to the deep dorsal vein of the penis, resulting in a blockage of venous outflow and in retrograde inflow into the corpora cavernosa. Complications arise as a result of persistently elevated blood pressure in the deep venous system and the erectile tissue in 10-20% of cases and are most often linked to dilatation of the shunt: the consequences are enlargement and induration of the glans, hazard of phimosis and paraphimosis, pulsation of the penis, micturation difficulties and, ultimately, ulceration of the glans. Surgical reduction of the arterial inflow ("banding" of the shunt) is the only therapeutic procedure that reduces hypervascularization without compromising the newly gained erectile function.

Arteriovenous Shunt, Surgical↗
PubMed1986

[Experiences up to now with diagnosis and microsurgical revascularization in disorders of erection].

Nine patients with impaired erection and a mean age of 41 years were diagnosed by means of a battery of multidisciplinary examinations: specific anamnesis, urological, neurological, endocrinological, angiological, psychosomatic and metabolic investigations, electromyography, measurement of the latency period and duration of the bulbocavernosus reflex, measurement of the nocturnal penis tumescence, penile blood-pressure index (PBPI), artificial erection with papaverine, flowmetry, phalloarteriography, dynamic cavernosonography. In all cases, an arterial and/or venous genesis was discovered as well as neurological or psychological factors. Three microsurgical techniques were employed: the end-to-side anastomosis of the A. epigastrica inferior preferably with the A. dorsalis penis (two cases), with the V. dorsalis penis profunda (four cases) and with the two combined (three cases). In the last cases, the vein was ligated or constricted proximal to the anastomosis. The primary factor in choosing the particular reconstruction method was the angiogram. Diagnosis entailed no complications for the patients. In addition to minor postoperative complications such as a hematoma, scar pains or hypervascularization of the glans and the corpus spongiosum, three early occlusions occurred in reconstructions up to one month postoperatively. One to five months after surgery the erectile potency had improved or normalized in seven out of nine patients, making intercourse possible. Two patients, the only two with a posttraumatic interruption in the bulbocavernosus reflex curve, showed no change. For purposes of postoperative control of arterio-venous anastomoses, the typical shunt sound is observed by stethoscope. After revascularization of the A. dorsalis penis, it is recommended that the PBPI be taken at the Aa. profundae penis and, when necessary, that a control angiography be performed. For the treatment of potency disturbances stemming from vascular causes, our results advocate that microsurgical vascular reconstruction be given due consideration before implantation of a penile prosthesis.

Adult↗
PubMed1985

Serum antibodies in patients with alveolar echinococcosis before and after therapy.

Thirty-three patients with alveolar echinococcosis treated by surgery or with mebendazole were observed up to six years. Of three immunoassays (IgG ELISA, complement fixation, indirect haemagglutination) correlation with the clinical course was achieved by IgG ELISA only. Serum antibody levels tended to increase during the first year and decreased during the second year after therapy had been started, Long persisting antibody was most sensitively indicated by indirect haemagglutination.

Antibodies↗
PubMed1983

[Clinical experiences with a new infusion system].

Fifty samples of an infusion system with a spherical drop chamber were tested and were found to function normally. The system's greatest advantage is that it can be applied in any position when used with flexible containers with pressure cuffs. While complications certainly are possible, they can be avoided. The system is particularly suitable for use in emergencies outside the clinic and while transporting patients.

Adult↗