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Biomedical subjects

P Schober

Publications and source records attributed to P Schober.

At least 19 recordsLinked to original sources
PubMed2006

Closed system anaesthesia--historical aspects and recent developments.

Closed circuit anaesthesia was described decades ago but did not achieve wide popularity among anaesthesiologists mainly because reliable control of inspiratory gas concentrations was not possible. Recent innovations including fast gas analysers, electronically controlled dosage systems and algorithms for feedback control have made possible the development of sophisticated closed circuit ventilators designed for routine clinical practice. The main advantages comprise economic use of medical gases and volatile anaesthetics, reduction of anaesthetic gas loss into the atmosphere, improved airway acclimatization as well as estimations of oxygen consumption. This article reviews historical aspects, recent developments as well as advantages and limitations of closed system anaesthesia.

Anesthesia, Closed-Circuit↗
PubMed2006

Partial liquid ventilation: effects of closed breathing systems, heat-and-moisture-exchangers and sodalime absorbers on perfluorocarbon evaporation.

BACKGROUND AND OBJECTIVES: During partial liquid ventilation perfluorocarbons are instilled into the airways from where they subsequently evaporate via the bronchial system. This process is influenced by multiple factors, such as the vapour pressure of the perfluorocarbons, the instilled volume, intrapulmonary perfluorocarbon distribution, postural positioning and ventilatory settings. In our study we compared the effects of open and closed breathing systems, a heat-and-moisture-exchanger and a sodalime absorber on perfluorocarbon evaporation during partial liquid ventilation. METHODS: Isolated rat lungs were suspended from a force transducer. After intratracheal perfluorocarbon instillation (10 mL kg(-1)) the lungs were either ventilated with an open breathing system (n = 6), a closed breathing system (n = 6), an open breathing system with an integrated heat-and-moisture-exchanger (n = 6), an open breathing system with an integrated sodalime absorber (n = 6), or a closed breathing system with an integrated heat-and-moisture-exchanger and a sodalime absorber (n = 6). Evaporative perfluorocarbon elimination was determined gravimetrically. RESULTS: When compared to the elimination half-life in an open breathing system (1.2 +/- 0.07 h), elimination half-life was longer with a closed system (6.4 +/- 0.9 h, P 0.05) when compared to a closed system. CONCLUSIONS: Evaporative perfluorocarbon loss can be reduced effectively with closed breathing systems, followed by the use of sodalime absorbers and heat-and-moisture-exchangers.

Absorption↗
PubMed2006

[Carbon monoxide: toxic molecule with antiinflammatory and cytoprotective properties].

Carbon monoxide arises during incomplete combustion of organic material, is incorporated into the circulation via the lungs and displaces oxygen from hemoglobin. Consecutively, symptoms of intoxication such as headache, vertigo, nausea, seizures and coma may result in a dose dependent fashion. Carbon monoxide is however also generated endogenously during heme degradation catalysed by heme oxgenase enzymes. The isoform hemeoxygenase-1 is inducible by oxidative stress and may mediate cytoprotection mainly attributable to endogenously produced carbon monoxide. Exogenous applied carbon monoxide has also been shown to confer protection in experimental studies. Meanwhile, in addition to the toxicological properties, antiinflammatory and cytoprotective effects of carbon monoxide have moved into the focus of scientific interest.

Animals↗
PubMed2005

Partial liquid ventilation in acute salt water-induced lung injury.

BACKGROUND AND OBJECTIVES: Salt-water aspiration results in pulmonary oedema and hypoxia. We tested the hypothesis that partial liquid ventilation has beneficial effects on gas exchange and rate of survival in acute and extended salt water-induced lung injury. METHODS: Anaesthetized, ventilated rats (tidal volume 6 mL kg(-1), PEEP 5 cmH2O) received a tracheal salt-water instillation (3%, 8 mL kg(-1) body weight) and were randomly assigned to three groups (n = 10 per group). While lungs of Group 1 were gas-ventilated, lungs of Group 2 received a single perfluorocarbon instillation (30 min after the injury, 5 mL kg(-1) perfluorocarbon) and lungs of Group 3 received an additional continuous perfluorocarbon application into the treachea (5 mL kg(-1) h(-1)) Arterial blood gases were measured with an intravascular blood gas sensor. RESULTS: Salt-water instillation resulted in a marked decrease in PaO2 values within 30 min (from 432 +/- 65 to 83 +/- 40 mmHg, FiO2 = 1.0, P < 0.01). Arterial oxygenation improved in all three groups irrespective of treatment. We observed no significant differences between groups in peak PaO2 and PaCO2 values. CONCLUSIONS: Our results suggest that partial liquid ventilation has no additional beneficial effects on gas exchange after life-threatening salt water-induced lung injury when compared to conventional gas ventilation with positive end-expiratory pressure.

Anesthesia↗
PubMed2004

Lung contusion-lacerations after blunt thoracic trauma in children.

Chest trauma in children is an indicator of injury severity and is associated with a high mortality rate. The aim of this study was to investigate the impact of pulmonary contusion-laceration on short and long-term outcome of pediatric patients after blunt thoracic trauma. A retrospective analysis of records of 41 children aged 10 months to 17 years who were treated for pulmonary and associated injuries between 1986 and 2000 was done concerning mode of injury, types of injuries, management and outcome. In addition, a follow-up investigation was performed 4.5+/-1 years after injury. Of the patients 27 were involved in motor vehicle accidents (MVA group) and 14 patients suffered other types of accidents (others group). The mean injury severity score (ISS) was 30+/-2 (range 9-75) with no significant difference between the groups. Patients from the MVA group suffered more frequently bilateral pulmonary lesions and needed more often chest tube placement ( p<0.05), 5 patients died (12%) all from the MVA group. The follow-up investigation of 34 patients showed unremarkable chest x-rays and normal lung function in all but 1 patient with bronchial asthma. In conclusion, children who recover after a pulmonary contusion-laceration trauma do not suffer from significant late respiratory problems.

Accidents, Traffic↗
PubMed1999

Contraceptive knowledge and behavior of conventionalists, careerists, idealists, bouncers, desperadoes, and outsiders.

The aim of the survey was to determine the contraceptive behavior and knowledge on contraceptive methods of adolescents. We defined six clusters according to personality, leisure activities, and sociodemographic characteristics: conventionalists, careerists, idealists, bouncers, desperadoes, and outsiders. 1010 Austrian adolescents aged 14-24 years participated in the survey. 96%-100% indicated that they were familiar with the condom and the contraceptive pill. The two most popular contraceptive methods cited were the condom (39%) and OC (34%). Whereas 40% of conventionalists reported that OC were their preferred method of contraception, 53% of idealists indicated that they preferred the condom. 66% of the desperadoes indicated that they considered the pill expensive. 85% of conventionalists and careerists believe that OC offer the best protection against pregnancy. Clusters with higher self-esteem and those with a higher educational level were more likely to believe that this method is unreliable. The results obtained indicate that outsiders, desperatoes, and bouncers show deficits in sex education; only careerists and idealists appeared to be better informed. Research on adolescent contraceptive behavior should drop the traditional stratifying criteria and appreciate the diversity of adolescent populations in order to be better able to classify adolescents according to their contraceptive attitudes.

Adolescent↗
PubMed1999

Evidence-based guidelines for the management of genital chlamydial infection in general practice. (Leicestershire Chlamydia Guidelines Group).

BACKGROUND: Valid clinical guidelines can be effective in improving patient care. Genital Chlamydia trachomatis infection is the commonest curable sexually transmitted disease (STD) in England and Wales and is an important cause of pelvic inflammatory disease (PID), tubal infertility and ectopic pregnancy. No published guidelines exist on managing genital chlamydial infection in British general practice. OBJECTIVE: We aimed to develop valid guidelines for the management of genital chlamydial infection for use in British general practice. METHODS: A district-wide postal questionnaire survey was used to document current clinical practice. A critical review of the evidence concerning the management of genital chlamydial infection as it relates to British general practice was performed. The information gained from the critical review and survey was used to develop evidence-based guidelines within a multidisciplinary guideline recommendation group. RESULTS: The guidelines covered the diagnosis, investigation, drug treatment and referral of adult male and female patients with genital chlamydial infection in general practice. CONCLUSION: Valid guidelines for the management of genital chlamydial infection have been developed for use in British general practice. Appropriate dissemination and implementation of the guidelines should lead to earlier detection and treatment of men and women with chlamydial infection and thereby reduce the incidence of PID, tubal infertility and ectopic pregnancy in women.

Adult↗
PubMed1999

A survey of contact tracing practice for sexually transmitted diseases in GUM clinics in England and Wales.

We set out to determine current policy and practice in relation to contact tracing (partner notification) for sexually transmitted diseases (STDs) within genitourinary medicine (GUM) clinics in England and Wales. A confidential postal questionnaire survey of all GUM clinics in England and Wales was undertaken. Completed questionnaires were returned by 105 GUM clinics (a response rate of 65%). All respondents undertook routine contact tracing for gonorrhoea and chlamydia. The most popular method of contact tracing used was patient referral. The majority of contact tracing was undertaken by health advisers. Information on the time period over which contact tracing was undertaken showed wide variation. Audit data on the effectiveness of contact tracing in terms of the proportion of sexual contacts seen were available from only a minority of GUM clinics (33/79, 42%). Only chlamydia (24/79, 30%) and gonorrhoea (22/79, 28%) were the subject of any appreciable audit activity. There is wide variation in contact tracing policy and practice in GUM clinics in England and Wales. Audit of contact tracing effectiveness appears to be a minority activity. Further research is needed before an evidence-based approach to contact tracing can be implemented.

Contact Tracing↗
PubMed1998

A model for the development of evidence-based clinical guidelines at local level--the Leicestershire Genital Chlamydia Guidelines Project.

Clinical guidelines can be effective in achieving health gain when they are validly developed, disseminated and implemented appropriately. There is, however, a potential conflict between the need for validity through use of expert resources available at a national level, and implementation, which is undertaken at local level and depends on the local relevance of the guideline. This paper presents a model by which valid guidelines for the management of a given disease (genital chlamydial infection) by general practitioners can be developed at local level using the resources available to a district health authority department of public health. The model has three elements. First, a district-wide postal questionnaire survey was used to document current clinical practice. Secondly, a critical review of the evidence relating to the management of genital chlamydial infection as it relates to British general practice was performed. Thirdly, the information gained from the critical review and survey was used by a multidisciplinary group to develop evidence-based guideline recommendations. It is argued that the Leicestershire Genital Chlamydia Guidelines compare favourably with other recently published national guidelines in terms of their development and content. Local guideline development of guidelines for selected topics can be practical and appropriate.

Chlamydia Infections↗
PubMed1997

GP's management of genital Chlamydia: a survey of reported practice.

BACKGROUND: Genital chlamydial infection is the commonest curable sexually transmitted disease in the industrialized world. Little is known about how GPs manage this condition. OBJECTIVES: We aimed to determine current knowledge concerning genital chlamydia among GPs and to establish how patients with this infection are managed in primary care. METHODS: A confidential self-administered postal questionnaire survey was sent to all 494 GPs in one English health district (Leicestershire). RESULTS: Completed questionnaires were returned by 290 GPs (a response rate of 59%). A much higher proportion of GPs had tested and/or treated female patients for chlamydia [70%, 95% confidence interval (CI) 64-75%] as opposed to male patients (20%, CI 15-25%). Female patients (70%, CI 64-75%) were also more likely to be managed in general practice than male patients (56%, CI 50-62%). A majority of GPs (66%, CI 60-72%) routinely used an appropriate method of testing for chlamydia although a high vaginal swab, an inappropriate method of testing, was used by a fifth of GPs (19%, CI 15-24%). A large number of different treatment regimes were used by GPs. The majority of GPs (85%, CI 79-89%) prescribed an appropriate antibiotic although few GPs (19%, CI 14-25%) specified a chlamydia treatment regime in accordance with accepted international guidelines with respect to drug, dosage and duration of therapy. CONCLUSIONS: Female patients with known or suspected genital chlamydial infection are commonly managed in UK general practice. There is scope to improve the management of this infection in general practice.

Anti-Bacterial Agents↗
PubMed1994

Ultrasound diagnosis of birth-related spinal cord trauma: neonatal diagnosis and follow-up and correlation with MRI.

Two neonates, one with complete and one with incomplete birth-related transection of the cervico-thoracic spinal cord, form the basis of this report. Ultrasound and MRI findings in primary diagnosis and follow-up are described. The aim of this contribution is to bring this serious birth complication to the attention of the reader, to present the obstetrical risk factors, to describe the clinical presentation of the newborns and to make suggestions to expand the field of indications for spinal sonography. The value of spinal ultrasound in the first six months of life is stressed, especially in comparison to MRI. For definitive assessment of the lesion (transectional or nontransectional) follow-up ultrasound studies for several weeks are required.

Birth Injuries↗
PubMed1993

[Experience of parents in home monitoring of apnea for prevention of sudden infant death (SIDS)].

89 of 119 parents of infants with apnea home monitoring answered to a standard questionnaire concerning different aspects of home monitoring. In almost all cases the home monitoring was finished at the begin of the study, lasting from six months to 12 months. The indications for an apnea monitor were: apparent life threatening event (n = 8), SIDS-sibling (n = 24), sleep apnea syndrome (n = 40) and parents pressing request (n = 17). 90% of parents felt to have got enough information about the function of the apnea monitor (mostly Graseby MR-10 monitor) and what they have to do when there is an apnea alarm. 6% of parents changed the monitor because of technical problems. Most of the alarms were registrated by almost all parents between 24 h and 6 h. 35% of parents stimulated their infants in case of an apnea alarm gently to vigorously, one infant had a mouth to mouth resuscitation. Questions concerning the psychological and social impact of home monitoring on parents demonstrated that there was some stress like anxiety, sleep disturbances mainly in the mothers. We conclude from parents experience with apnea home monitoring the need for an adequate medical, technical and psychological support.

Adaptation, Psychological↗
PubMed1991

Quantification of Candida albicans morphology in vaginal smears.

The morphology index (Mi) of Candida albicans cells was determined by microscopic image analysis in vaginal smears from 26 patients. The morphology of the cells typically showed a broad distribution of forms, but the mean Mi was greater than 2.0 in 23/26 instances, indicating a preponderance of pseudohyphal and hyphal forms. No association could be found between Mi and the clinical assessment of signs or symptoms of Candida infection. Comparison of these 26 patients with 43 others who had Candida-positive vaginal smears but with fewer than 15 fungal cells in the smear revealed significantly lower scores for vulvovaginal symptoms among the latter.

Candida albicans↗