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Biomedical subjects

R L Haberl

Publications and source records attributed to R L Haberl.

At least 19 recordsLinked to original sources
PubMed2007

[Metabolic syndrome and peripheral arterial occlusive disease as indicators for increased cardiovascular risk].

BACKGROUND AND AIMS: The usefulness of the metabolic syndrome (MetS) or a low ankle brachial index (ABI), respectively, to identify patients with high risk for cardiovascular events has repeatedly been postulated. However, robust data on the prevalence and prognosis of such patients are missing in the primary care setting. PATIENTS AND METHODS: In the prospective, non-interventional "German epidemiological trial on Ankle Brachial Index (getABI) at total of 6880 unselected patients > or = 65 years were observed by their General Practitioners over 3 years. Death and cardiovascular events were recorded. The definition of MetS was similar to the one of NCEP ATP III (National Cholesterol Education Program--Adult Treatment Panel III). ABI (ratio of the systolic blood pressures measured at the distal part of the calf and at the upper arm) was measured with Doppler sonography. Peripheral arterial disease (PAD) was defined as ABI <0.9 or peripheral revascularization/amputation owing to PAD. Survival analyses were conducted with a Cox proportional hazard model. Hazard rate ratios (HRR, 95 % confidence intervals, CI) were multvariate adjusted. RESULTS: The observation time for the total cohort was more than 20,000 patient years (PY). Cardiovascular mortality in patients with MetS (n = 3040, 44 %) compared to patients without MetS (n = 3795; 55 %) was doubled (8.5 vs. 4.0 per 1,000 PY; HRR: 2.0; CI 1.3 - 2.9). Concomitant presence of MetS and PAD (n = 651; 9.5 %) increased the mortality risk compared to patients without both conditions (n = 3194; 46.4 %) drastically (21.1 vs. 3.0 per 1000 PY; HRR: 5.7; CI: 3.5 - 9.4). Similar significant risk increases also were noted for all-cause mortality or a combined endpoint of mortality and vascular morbidity. Further, in lower ABI categories cardiovascular event rates increased. CONCLUSIONS: Patients with MetS carry a substantially increased risk of premature death, especially cardiovascular death, and therefore require intensive treatment of their risk factors. This holds especially true if concomitant PAD is present.

Aged↗
PubMed2006

[Improvement in stroke care in a non-urban community hospital--quality of procedures before and after participating in a telemedical stroke network].

BACKGROUND: Although treatment in a stroke unit has been proven to be effective, most stroke patients in rural areas have no access to it. The community hospital of Ebersberg (Bavaria/Germany) joined the Telemedic Project for Integrative Stroke Care (TEMPiS) in order to optimize the quality of stroke care. This analysis focuses on changes in stroke management using generally accepted indicators for quality of acute stroke treatment. METHODS: The core elements consisted of the setting up of a stroke ward in the community hospital, continual stroke education and a 24-hour telemedical consultation service offered by stroke centers. Treatment of stroke patients was documented during two 12-months periods before the project was started start (i.e. retrospectively) and during the course of the project (prospectively). In addition, data on fatal outcome and institutionalization of patients who had lived at home before the qualifying event were collected 12 months after stroke onset. RESULTS: There were 299 admissions for stroke or transient ischemic attacks between 1 Nov 2001 and 31 Oct 2002, and 305 between 7 July 2003 and 6 June 2004. Length of in-hospital stay decreased from 12.1 to 9.2 days. More patients (10.3 vs. 1.3%) were transferred to other acute hospitals during the later period. Indicators for stroke care quality improved: numbers of cerebral imaging rose from 56.5% to 96.4%, of duplex sonography of cervical arteries from 43.5 to 72.8 %, of speech therapy from 0% to 50.8% and of occupational therapy from 0 to 33.4%. One year after admission, 18.9% and 17.2%, respectively, of the patients had died, while 10.2% and 6.1% were living in institutions. CONCLUSION: Participation in the TEMPiS network substantially improved stroke care quality according to national and international guidelines. These improvements may lead to a better prognosis after a stroke.

Computer Communication Networks↗
PubMed2005

[Problems of emergency transfers of patients after a stroke. Results of a telemedicine pilot project for integrated stroke accommodation in southeast Bavaria (TEMPiS)].

BACKGROUND: Specific stroke subtypes like subarachnoid hemorrhages or malignant brain infarcts require immediate interventions, but treatment options are offered mainly in specialized centers. For this reason, interhospital transfers from primary hospitals need to be done without delay. METHODS: The telemedic pilot project for integrative stroke care (TEMPiS) connects 2 stroke centers and 12 regional hospitals in Bavaria (Germany). Core elements are the implementation of stroke wards, telemedic consultation and improvement of emergency interhospital transfers. Organization of patient transports is offered by the central telemedic service. During the first 12 months of the continuing project all interhospital transfers initiated by the central telemedic service were prospectively documented. Emergency transports were analysed according to diagnosis, type of transport, distance and time delays. RESULTS: A total of 252 interhospital transfers were recommended in teleconsultations; finally 221 transports took place. Median total duration of transfers (including the necessary arrangements) was 134 min (interquartile range: 105-219) for intracerebral hemorrhages (N = 58), 138 min (95-157) for subarachnoid hemorrhages (N = 31), 161 min (100-230) for malignant infarcts (N = 22) and 147 min (109-180) for suspected basilar artery occlusion (N = 28). Time from admission in the primary hospital to initiation of interhospital transfer was 135 min (median; interquartile range: 86-172), transport time was 81 min (60-116). Helicopter transport did not save time for transfer distances up to 50 kilometres, compared to transport via ambulance (including assistance of hospital physicians). Transport using a special intensive care vehicle was much more time consuming because of the longer transport preparation time. CONCLUSION: Emergency transfers of stroke patients are time consuming. This may contribute to additional harm being done to severely ill patients. Faster organization and conduct of transports is required.

Brain Infarction↗
PubMed2005

[Apoplexy--current status of diagnostics and therapy].

During the past years increasingly stricter criteria have been applied to the primary prevention of ischemic stroke. This applies especially to the treatment of asymptomatic carotid stenosis. An operation is indicated for a blockage of 60% and higher, including symptom-free patients under 75 years of age. At the moment, a final conclusion on the preferred operative procedure--thromboendarterectomy or stent implantation--cannot be made. For the secondary prevention of apoplexy, the highest relative risk reduction for vascular accidents using thrombocyte aggregation inhibitors was achieved with the combination ASA plus dipyridamole. Diuretics, calcium antagonists, ACE inhibitors and angiotensin receptor blockers (ARB) are equally suitable for the reduction of blood pressure after apoplectic insult. Moreover, the latter appear to have advantages for the prevention of a renewed apoplexy. The benefit of statins in the secondary prevention of apoplexy has been substantiated by the Heart Protection Study. Simvastatin has the best evidence for its effectiveness in patients without CHD; in contrast, atorvastatin has possibly more benefits for patients with clinically evident CHD. The direct thrombin inhibitor, ximelagatran, will be available as an alternative to the oral anticoagulant marcumar in the foreseeable future.

Anticholesteremic Agents↗
PubMed2004

Antioxidant status in acute stroke patients and patients at stroke risk.

BACKGROUND AND PURPOSE: Antioxidant enzymes like copper/zinc superoxide dismutase (SOD), catalase and gluthatione peroxidase (GSHPx) are part of intracellular protection mechanisms to overcome oxidative stress and are known to be activated in vascular diseases and acute stroke. We investigated the differences of antioxidant capacity in acute stroke and stroke risk patients to elucidate whether the differences are a result of chronic low availability in arteriosclerosis and stroke risk or due to changes during acute infarction. METHODS: Antioxidant enzymes were examined in 11 patients within the first hours and days after acute ischemic stroke and compared to risk- and age-matched patients with a history of stroke in the past 12 months (n = 17). Antioxidant profile was determined by measurement of glutathione (GSH), malondialdehyde (MDA), SOD, GSHPx and minerals known to be involved in antioxidant enzyme activation like selenium, iron, copper and zinc. RESULTS: In comparison to stroke risk patients, patients with acute ischemic stroke had significant changes of the GSH system during the first hours and days after the event: GSH was significantly elevated in the first hours (p < 0.01) and GSHPx was elevated 1 day after the acute stroke (p < 0.05). Selenium, a cofactor of GSHPx, was decreased (p < 0.01). GSHPx levels were negatively correlated with National Institutes of Health Stroke Scale (NIHSS) scores on admission (r = -0.84, p < 0.001) and NIHSS scores after 7 days (r = -0.63, p < 0.05). MDA levels showed a trend for elevation in the first 6 h after the acute stroke (p = 0.07). No significant differences of SOD, iron, copper nor zinc levels could be identified. CONCLUSIONS: Differences of antioxidant capacity were found for the GSH system with elevation of GSH and GSHPx after acute stroke, but not for other markers. The findings support the hypothesis that changes of antioxidant capacity are part of acute adaptive mechanisms during acute stroke.

Aged↗
PubMed2004

[Telemedicine stroke department network. Introduction of a telemedicine pilot project for integrated stroke management in South Bavaria and analysis of its efficiency].

More than 100 stroke units have been established in Germany. In rural areas, however, acute stroke care needs to be improved. In order to advance clinical stroke therapy, two specialized stroke centers founded a telemedicine network (TEMPiS) among 12 community hospitals in eastern Bavaria. Each network hospital established specialized stroke wards where qualified teams manage acute stroke patients. Twenty-four hours daily, physicians in local hospitals are able to contact the stroke centers via videoconferencing including transmission of digital DICOM data. To study the efficacy of this network, a controlled trial will be performed. Five TEMPiS-network hospitals will be matched with five other hospitals equal in size, catchment area, and diagnostic techniques. For about 1 year, all consecutive stroke cases in the matched study hospitals will be prospectively recorded in a database. Neurological deficits will be quantified on the National Institute of Health Stroke Scale within 24 h after stroke onset. Mortality and institutional care as a combined primary endpoint will be assessed after 3 and 12 months. Furthermore, functional outcome according to the modified Rankin scale, Barthel score, and quality of life will be assessed using a standard telephone interview. Data acquisition started in July 2003, and final results are expected in 2005.

Centralized Hospital Services↗
PubMed2003

[Secondary prevention after stroke: healthy life style, oral anticoagulation].

For patients who suffered a TIA or a stroke the risk of a second event is high. The recurrence rate, however, can be significantly reduced by a number of prophylactic strategies. Methods for secondary stroke prevention include a healthy lifestyle, intensive body exercise, a low cholesterol diet, and the cessation of smoking. High levels of blood pressure, cholesterol and blood glucose should be rigorously controlled. In particular, blood pressure levels should remain below 135/85 mmHg including a physiological day/night profile. All patients at high risk for cardiac embolism should receive oral anticoagulants. As the risk for embolic events increases with age (especially in patients with atrial fibrillation), a rigid "age-cutoff" for anticoagulation is not justified.

Administration, Oral↗
PubMed2003

L-arginine improves diminished cerebral CO2 reactivity in patients.

BACKGROUND AND PURPOSE: There is experimental evidence that L-arginine restores diminished CO2 reactivity after mild traumatic brain injury in rats. This effect is believed to be mediated by L-arginine-derived nitric oxide, which is a permissive substrate for CO2 reactivity. To clarify whether these findings can be transferred to the clinical situation and have beneficial effects in patients, we studied the effects of L-arginine on CO2 reactivity of the cerebral vessels in patients with impaired vasomotor reactivity (VMR) and compared them with patients with normal VMR. METHODS: Twenty-two patients with cardiovascular risk factors and VMR <50% with no extracranial or intracranial stenoses were examined by bilateral transcranial Doppler sonography of the right and left middle cerebral arteries and compared with 20 age- and risk-matched patients with normal VMR (>50%). VMR was tested by L-minute hyperventilation, followed by a 3-minute inhalation of 5% CO2. Examinations were performed before and after infusion of 30 g L-arginine over 30 minutes. The 22 patients with reduced VMR (<50%) were compared with 20 patients with normal VMR (>50%). RESULTS: Initial mean VMR of the 42 patients was 50+/-12%. There was no difference between the right- and the left-side VMR. In the 22 patients with reduced VMR in the first examination (42+/-8%), VMR increased significantly after infusion of L-arginine (52+/-14%, P=0.005). In contrast, values did not change after infusion of L-arginine in the 20 patients with normal VMR (59+/-8% before versus 59+/-13% after L-arginine). There was a negative correlation of initial CO2 vasoreactivity and the percentage of VMR increase after infusion of L-arginine. CONCLUSIONS: Our data support the hypothesis that in humans L-arginine is able to improve impaired CO2 reactivity of the cerebral vessels. This effect can be found in patients at cardiovascular risk with impaired VMR and might have therapeutic implications in the future.

Aged↗
PubMed2003

[Transient cerebral ischemia--precursors of stroke. Can warning signs be recognized?].

Transient ischemic attacks (TIA) are neurological deficits of sudden onset and equally sudden reversal. They are considered to be precursors of stroke that (still) have a good prognosis. Since the symptoms have usually disappeared by the time of the first examination the physician must rely on the information provided by the patient or relatives for the medical history. Symptoms to look for include disordered speech, aphasia, vertigo, unilateral arm paralysis, crooked mouth. When a TIA is suspected, the following examinations are mandatory: neurological ultrasound, blood pressure, ECG, laboratory examinations (blood sugar, blood count, hematocrit), CT or MRI, Doppler-ultrasonography of the carotids and, where indicated, transcranial Doppler. Long-term prophylaxis with platelet antiaggregation agents or Marcumar (phenprocoumon) and appropriate changes in lifestyle are indicated for all TIA patients. When the indication is established, thrombarterectomy must be carried out within six months after the event.

Aspirin↗
PubMed2003

R1--systemic thrombolysis in German stroke units--the experience from the German Stroke data bank.

BACKGROUND: Systemic thrombolysis with tissue plasminogen activator (t-PA) for treatment of acute ischemic stroke was approved in Germany in 2000. Up to now, only data from single centers have been available for the study of the use of thrombolysis in a hospital-based approach outside controlled trials. We therefore sought to determine the frequency of application and complications as well as the patient outcome after t-PA treatment in clinical routine of specialized stroke centers in Germany. METHODS: Within the German Stroke Data Bank Collaboration, 6234 consecutive patients with ischemic stroke were prospectively documented in 20 stroke centers between 1998 and 1999. The patients were centrally followed via telephone interview after 3 months and 1 year to assess global functional outcome using the Modified Rankin Scale. RESULTS: 250 patients (4 %) received systemic t-PA treatment during the study period. The baseline characteristics of these patients were comparable to large clinical trials and phase IV studies. Symptomatic and asymptomatic parenchymal hemorrhage occurred in 22 patients (8.8 %) and was fatal in 3 patients. Follow-up data after 3 months were obtained in 82.4 % of all patients, of which 35 % had a favorable functional outcome (mRS </= 1), while 23.8 % were severely disabled (mRS >/= 4) and 17 % had died. CONCLUSION: The results of our study agree with the assumption that thrombolytic therapy can be performed safely and effectively in daily clinical practice. Nevertheless, the small proportion of patients receiving thrombolysis even in specialized stroke centers calls for further improvement of acute stroke management in Germany.

Cerebral Hemorrhage↗
PubMed2002

[Diagnosis related groups in stroke treatment. An analysis from the stroke data bank of the German Stroke Foundation].

BACKGROUND: The upcoming introduction of diagnosis related groups (DRG) as an exclusive base for future calculation of hospital proceeds in Germany requires a thorough analysis of cost data for various diseases. OBJECTIVE: To compare the resulting combined cost weights of the Australian Refined DRG system (AR-DRG) with the proceeds based on actual per-day rates in stroke treatment. PATIENTS AND METHODS: Between 1998 and 1999, data from 6520 patients (median age 68 years, 43% women) with acute stroke or transient ischemic attack (TIA) were prospectively documented in 15 departments of Neurology with an acute stroke unit, 9 departments of general Neurology and 6 departments of Internal Medicine. Prior to grouping cases into DRGs, all available data were transferred into ICD-10-SGB-V 2.0 or the Australian procedure system (MBS-Extended). Hospital proceeds for the respective cases were calculated based on per-day rates of the documenting hospitals. RESULTS: The resulting cost weights demonstrate a good homogeneity compared to the length of stay. When introducing the AR-DRG with a uniform base rate in Germany, a relative decrease of hospital proceeds can be expected in Neurology Departments and for treatment of TIAs. CONCLUSION: Preservation of the existing structure of acute stroke care in Germany requires a supplement to a uniform base rate in Neurology departments.

Acute Disease↗
PubMed2001

[Patient with suspected apoplexy. A case for the stroke unit?].

Stroke units are monitoring centers providing for acute diagnostic work-up, immediate treatment and initial rehabilitation measures in patients suffering a stroke. Indications for admission to a stroke unit are, firstly, a suspected fresh stroke or a transient ischemic attack, provided the symptoms are not older than 24 hours, and, secondly, progressive, unstable symptoms. A major aspect of the stroke unit is the establishment of a differential diagnosis, which provides the basis for establishing the urgent treatment of an apoplectic attack. The goal is to prevent the progression of symptoms, which occurs in one-third of patients and leads to permanent sequelae. Using a number of cases, the activities of a stroke unit are described. To improve the acute management of such patients, a close network of regional and national stroke units needs to be put in place.

Adult↗
PubMed2000

[When lowering blood pressure is risky. Cerebral infarct--the paradox of prevention and acute therapy].

The value of a sustained lowering of elevated blood pressure below 140/80 mmHg for primary and secondary prevention of stroke has been demonstrated in controlled studies. In contrast, active lowering of blood pressure in the acute phase of a cerebral infarction is associated with the risk of causing further damage to the brain by reducing perfusion in the region of disordered vascular autoregulation surrounding the ischemic area ("penumbra"). The recommendations of a European Consensus Conference therefore apply, that in the first three days following an acute stroke the blood pressure should be cautiously lowered only when a systolic pressure of 220 mmHg or a diastolic pressure of 120 mmHg is exceeded.

Antihypertensive Agents↗
PubMed2000

[Comparison of the annual data of 2 stroke units in neurological clinics of acute hospitals].

The Stroke Unit concept of the German Neurological Society differs from its precedents in Scandinavia or the United Kingdom. Hallmarks of the German concept are very early onset of diagnosis and treatment, continuous surveillance of vital functions by bedside monitors and specialized care by a multiprofessional team. This comparison of two Stroke Units in Minden and Munich-Harlaching, working according to the new German concept, shows broad similarities in admission intervals, diagnostic procedures, treatment modalities and short term prognosis, with an exceedingly low in-hospital mortality of 3.4-5.6% and a high proportion of patients (64-69%) leaving the hospital with Barthel scores above 70. Ongoing studies will show how this kind of Stroke Unit treatment compares to general wards.

Aged↗
PubMed1999

[Blood glucose and stroke].

There is strong evidence that severe hypoglycemia can worsen the prognosis in acute stroke. In contrast, the influence of acute hyperglycemia on cerebral ischemia remains controversial. The conflicting results of clinical and experimental studies can partly be explained if different stroke subtypes are regarded separately and the time course of the blood-glucose level during the acute insult is taken into account. Hyperglycemia seems to worsen the neuronal injury during the subacute period of cerebral ischemia if there is insufficient collateral blood supply. Furthermore, it increases the risk of hemorrhagic transformation in this time interval. In contrast, acute hyperglycemia may protect neuronal tissue from structural damage by improving the substrate supply if there is only a moderate decrease in cerebral blood flow. This situation is observed in the penumbra and if good collateral blood supply is provided. We therefore hypothesize that both negative and positive effects of acute hyperglycemia depend on the local cerebral blood flow.

Blood Glucose↗
PubMed1999

[Clinical diagnosis and stroke subtypes].

Sudden focal neurological symptoms are caused by stroke in 95%, either ischemic or hemorrhagic. Diagnosis and onset of treatment has to be rapid because the tolerance of the brain tissue to ischemia is lower than in any other tissue. First priority has stabilization of vital parameters such as maintenance of high blood pressure, rehydration, oxygen supply and correction of hyper-/hypoglycemia. Of equal importance is the prompt imaging of the brain to differentiate bleeding, complete brain infarction and early ischemic signs--only the latter permitting recanalization procedures by thrombolysis in a narrow time window of three hours. Distinct etiological diagnosis by Duplex scanning and echocardiography usually follows. This information determines the stroke subtype and the choice of secondary prevention measures.

Brain Ischemia↗