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Biomedical subjects

R Schüppel

Publications and source records attributed to R Schüppel.

At least 19 recordsLinked to original sources

[Illness behavior and expectations on physician-patient relationships of medical students in the second and fifth year of education].

We investigated illness behaviour and treatment expectations of future physicians. 209 medical students in their second and 110 students in their fifth year of education were examined by means of a specific questionnaire and the Biographic Inventory for Diagnosis of Abnormal Behaviour (BIV). As to our questionnaire we found a six factors solution that could explain 44% of the variance. Students in the fifth year of education were more critical towards physicians, waited longer until they took advantage of professional help, tried more to influence both the diagnostic and therapeutic process and they adhered stronger to a psychosocial concept of illness than the second year students. Women desired more psychological support and fell back on household remedies more often than men. Students who had experienced a poor parent-child-relationship also were dissatisfied with their physician-patient-relationship. Introverted students were less demanding towards their physicians and more often searched for help in the lay system than extroverted students. With these factors, behaviour, experiences and attitudes of medical students with reference to a potential or actual patient role can be well described.

Adult↗

Sex differences in selection of pacemakers: retrospective observational study.

OBJECTIVE: To evaluate the effect of patients' sex on selection of pacemakers. DESIGN: Retrospective univariate and multivariate analysis of a large database. SETTING: German central pacemaker register. SUBJECTS: Records collected at the register for 1992 and 1993 (n=31 913), covering 64% of all implantations in Germany. MAIN OUTCOME MEASURE: Probability of receiving a single chamber, dual chamber, or rate responsive pacemaker in relation to sex. RESULTS: Univariate analysis showed that women were more likely to receive single chamber pacemakers and less likely to receive dual chamber or rate responsive systems than men. After demographic and clinical variables were controlled for, women were still more likely to receive a single chamber system (atrial pacing: odds ratio 0.89, 95% confidence interval 0.74 to 1.07; ventricular pacing: 0.85, 0.80 to 0.92) and less likely to receive a dual chamber (1.20, 1.12 to 1.30) or a rate responsive system (1.26, 1.17 to 1.37) than men. CONCLUSIONS: The data suggest sex differences in the selection of a pacemaker system which cannot be explained by the underlying cardiac disorder. Further research is needed to evaluate why guidelines for implanting pacemakers are not better adhered to.

Aged↗

[Interdisciplinary longitudinal curriculum "Medical Psychology, Psychotherapy and Psychosomatics." Experiences from the preclinical segment].

The departments of Medical Psychology, Psychosomatics and Psychotherapy developed an interdisciplinary longitudinal curriculum in order to coach medical students for the whole length of their medical education. Experiences from the first four undergraduate semesters are reported. 46 students (33 females, 13 males), mean age 22.3 +/- 2.6 years, attended 60 hours of interdisciplinary group sessions. Frequent motives to join the course were interest in psychosocial disciplines and relevant previous experience. The students expected to benefit from this project in their study, their future practice as a physician, and in their personal development. Important educational goals that could be attained were the adoption of a patient-centred view in medicine as well as strengthening of the students' critical capacities and sensitivity. The students especially appreciated the possibility of group discussions and the opportunity to participate actively in the course. Based on a critical review of the evaluation, the possibility of a transfer of our model is considered and perspectives for the future are developed.

Adult↗

Teaching psychosomatic medicine: predictors of students' attitudes toward a compulsory course.

One hundred five medical students (59 males, 46 females, mean age 25.7 +/- 2.5 years) were asked to evaluate a one-semester course in psychosomatic medicine. Overall satisfaction with the course was good. Neither demographic data nor individual characteristics such as previous personal experience in psychosocial medicine, professional goals, or preferred theoretical model of medicine were significantly correlated with single evaluation criteria or overall satisfaction with the course. The latter was most significantly related to the teachers' performance (r = 0.80).

Adult↗

[Significance of cognitive processes in drug research in the 19th century--exemplified by nitroglycerin].

The history of the discovery and development of drugs is replete with examples where chance and "serendipity" have resulted in important advances of knowledge. In the case of nitroglycerin it can be shown that what appears to have been a chance discovery was actually the result of a sequence of selective perceptions by, and cognitive processes in individual researchers. The sources allow insight into various stages of the development of nitroglycerin, starting with the chemical synthesis as an explosive in 1846 and the first use in humans in 1847 to the discovery of a useful coronary drug. Homeopathic medicine contributed significantly to this process. Thus, the history of nitroglycerin is an example of an exchange of knowledge between otherwise separate realms of sectarian and orthodox medicine in the second half of the 19th century.

Angina Pectoris↗

Subjective symptoms and quality of life in healthy subjects during a phase I study.

OBJECTIVE: Participants in a phase I study were interviewed in order to establish the incidence and variability of subjective symptoms and changes in quality of life during phase I trials. METHODS: The healthy subjects were randomized to receive a single dose of either 0.5 mg digoxin or an equivalent amount of each of four digitaloid mixtures every 14 days. The trial involved five 24-h monitoring periods. The duration of the study was 57 days. Wellbeing, subjective symptoms and quality of life were measured before, during and after the trial using the Freiburg Symptoms List (FSL), Wellbeing Scales (WBS), and Life Satisfaction Questionnaire (LSQ). RESULTS: Eight healthy subjects (25 years) were enrolled in the study. Their subjective symptoms were below the reference values for healthy subjects for each test but above the theoretical minimum and maximum values for total wellbeing, indicating that healthy subjects-not just patients-display subjective symptoms and impairment of wellbeing to a greater or lesser extent prior to a clinical trial. In terms of the total study population, comparison of the questionnaire scores before, during and after the study disclosed no significant changes in wellbeing or quality of life. However, some participants displayed marked intraindividual fluctuation. CONCLUSIONS: A careful exploration of the baseline symptoms is necessary even in healthy subjects to avoid observation bias. The symptom course differs greatly from individual to individual; therefore in a phase I study only group scores of wellbeing should be used to assess the possible effects of trial-related factors. A setting like the one used in our study does not impair the quality of life of healthy subjects and as such can be regarded as a fairly neutral means of measuring wellbeing.

Adolescent↗

[Education in psychosomatic medicine/psychotherapy at German universities: a critical evaluation of the current status].

The integration of psychosomatics/psychotherapy into the medical curriculum has not yet resolved the majority of problems in conveying a bio-psycho-social perspective to medical students. A survey, conducted 1992/93 at the university departments of psychosomatics-psychotherapy in Germany yielded that there is no true integration of a bio-psycho-social perspective into the curriculum up until now. A second investigation with students of the university of Ulm in 1993 revealed that there is substantial variety in the quality of teaching and that improvement is possible with resources already available. Consequences with regard to changes to be expected by the 8th renewal of the present teaching regulations ("Approbationsordnung") are discussed. A pilot project aiming at the integration of preclinical and clinical aspects of the psychosocial aspects of medicine is outlined.

Curriculum↗

[Psychosomatic aspects of pacemaker therapy].

Modern pacemaker therapy offers a highly differentiated treatment of symptomatic bradycardia, hardly susceptible to failure, combined with low operative intervention and risk. Only little attention has been paid to psychosocial aspects during the past; this explains the sketchy knowledge of this field. Prior to implantation there is, at first, a high rate of depression, which decreases after the operation. A number of favourable and unfavourable factors are described, concerning the acute and the long-term adaptation to the unit. Emotional and cognitive functions usually improve significantly during the follow-up period compared to the pre-operative state. This fact as well as social rehabilitation, which can only be realized partially, lead to an acceptable quality of life; therefore, for the majority of pacemaker patients, no essential modification of the usual control examinations seems to be necessary. But a small group of risk patients need the enhanced attention of their cardiologists and eventually interdisciplinary assistance.

Adaptation, Psychological↗

Acute cholestatic hepatitis and the sudden rise of the pacing threshold 5 weeks after VVI-pacemaker implantation.

The patient we describe developed a cholestatic hepatitis and an unusual threshold elevation of about 425%, coincidently, 5 weeks after pacemaker implantation. Lead dislocation, myocardial infarction or metabolic disorder could be excluded as a reason for the pacemaker complication. Neither a biliary obstruction nor an infection of the liver could be found to explain the liver injury. Most probably, both disorders were caused by propafenone (450 mg day-1), withdrawal of the drug resulted in normalization of elevated enzyme and threshold levels.

Acute Disease↗

A map of VH genes located next to the DH region in the Igh locus of two congenic Igh-recombinant mouse strains.

A new congenic mouse strain (C57BL/6-Igh-Vb-Ca) with a recombinant chromosome 12 is described. It carries the Igh-1a allele, but shows the serological characteristics of C57BL/6 when analyzed for idiotype expression with respect to the antigens dextran and (4-hydroxy-5-iodo-3-nitrophenyl)acetyl (NIP). We analyzed liver DNA from one animal for restriction fragment length polymorphism by hybridization to probes detecting members of nine VH gene families and DH segments, and compared it to DNA from animals carrying the nonrecombinant haplotypes Igha and Ighb, respectively. The breakpoint of recombination maps to the region carrying members of VH gene families VGAM3.8, PC7183 and Q52. The CB8KN strain which according to the serological analysis carries a recombinant Igh locus (Igh-Va-Cb) on BALB/c background was also analyzed. In this strain the breakpoint of recombination again maps to the region carrying members of VH gene families VGAM3.8, PC7183 and Q52. Our results show that the VH genes of families PC7183 and Q52 are interspersed and map to the region next to the DH locus. At least one gene from the VGAM3.8 family also maps to this region in the Igha and the Ighb haplotype.

Animals↗

Monoclonal anti-allotype antibody towards BALB/c IgM. Analysis of specificity and site of a V-C crossover in recombinant strain BALB-Igh-Va/Igh-Cb.

Polyclonal IgM obtained by fractionation of a BALB/c serum pool was used as the immunogen for C57BL/6 mice. Draining lymph nodes from selected animals donated cells for fusion with myeloma Sp-2/0. Fifteen hybridomas were productive, and one (RS-3.1) was cloned and the affinity-purified product analyzed for its reactivity pattern by MOPC 104E-enzyme-linked immunosorbent assay inhibition. Among five BALB/c myelomas only TEPC 183 (IgM) was active, not those belonging to other Ig classes. Among normal sera from 8 mouse strains only those of BALB/c, DBA/2J and CBA/J showed inhibition. The recombinant strain BALB-Igh-Va/Igh-Cb did not react, which shows that its C mu stems from parental strain C57BL/6, and that therefore the recombination event had occurred 5' of this gene.

Animals↗

Investigations on antipyrine metabolism V. Differentiation of two isomeric hydroxyantipyrine glucuronides by field desorption and fast atom bombardment mass spectrometry.

The glucuronide conjugates of the two isomeric antipyrine phase I metabolites of antipyrine in man, 4-hydroxyantipyrine and 3-hydroxymethylantipyrine have been analysed by field desorption and fast atom bombardment mass spectrometry. These isomers could be clearly distinguished on the basis of their fragmentation behaviour which was found to correlate with that observed under pyrolysis electron impact conditions.

Antipyrine↗

Isolation and characterization of the four antipyrine glucuronides and determination of their urinary excretion pattern in man by a reversed-phase h.p.l.c. assay.

A large-scale procedure for the isolation of four urinary glucuronides in antipyrine metabolism is described; the isolated compounds are used as standards in a direct h.p.l.c. assay. The four glucuronides were characterized by u.v. and 1H-n.m.r. spectroscopy, and after hydrolysis by a t.l.c. assay of the corresponding aglycones. A reversed-phase h.p.l.c. assay procedure has been developed for the direct quantification of the four antipyrine glucuronides; this separates 3-hydroxymethyl-antipyrine glucuronide, 4,4'-dihydroxy-antipyrine glucuronide, norantipyrine glucuronide and 4-hydroxy-antipyrine glucuronide in a single run. Urinary elimination patterns of these glucuronides have been determined in five female and five male volunteers after antipyrine (1200 mg) administration. The direct assay of urinary glucuronides enables the simultaneous determination of glucuronidation activities and four different phase-I metabolites of antipyrine in vivo.

Adult↗

Quantitation of norantipyrine sulphate and norantipyrine glucuronide as major metabolites of antipyrine in man and rat.

Two assay procedures are described for the quantitation of norantipyrine sulphate and norantipyrine glucuronide present in biological material. One, a selective acid hydrolytic assay procedure that affords the discriminative determination of both conjugates without prior separation, measures free norantipyrine by tlc-uv. The other is a tlc separation procedure for intact norantipyrine conjugates, which, in conjunction with radiolabelled material, derived from [3-14C]antipyrine, enables the direct quantitation of both conjugates independently. In man, about 25% of dose of antipyrine (1200 mg) was excreted as norantipyrine glucuronide within 48 h. The amount of norantipyrine sulphate was small. In the rat, norantipyrine sulphate represented about 15-20% of the dose of antipyrine (40-50 mg kg-1); no norantipyrine glucuronide was formed. Free norantipyrine has not been detected in urine of either species after antipyrine dosage. Pretreatment with 3-methylcholanthrene in the rat substantially enhanced excretion of norantipyrine sulphate, whereas induction with phenobarbitone was without effect on the microsomal N-demethylation of antipyrine. The lability of free norantipyrine was examined under different conditions and contrasted with the relative stability of norantipyrine conjugates. Two of the main degradation products of norantipyrine were identified as 4-phenylazo-norantipyrine and a 4,4'-bipyrazole-derivative.

Adult↗

Investigations on antipyrine metabolism. II--Analysis of conjugated metabolites of antipyrine in rat and human urine by off-line combination of liquid chromatography and field desorption mass spectrometry.

The complex pattern of conjugates in the metabolism of antipyrine in man and rat has been investigated using an off-line combination of liquid chromatography and field desorption mass spectrometry. Using this approach, field desorption mass spectrometry enables the direct identification of underivatized glucuronides and sulphates in antipyrine metabolism on the basis of the corresponding protonated or cationized molecules representing the base peaks in the field desorption mass spectra. All conjugated metabolites of antipyrine established so far--four glucuronides and three sulphates--were identified in extracts of urine after stepwise purification by column chromatography and subsequent mass spectrometric analysis.

Adult↗

Preparative isolation and purification of urinary conjugates in antipyrine metabolism in man and rat.

A series of six major urinary conjugates in the metabolism of antipyrine in man and rat has been investigated. A preparative isolation procedure has been developed using chromatography of methanolic extracts from urine on silica gel. In a two-step chromatographic procedure, methanolic extracts are first separated in 1) a "free fraction", containing unconjugated phase-I-metabolites and unchanged antipyrine, 2) a sulfate fraction and 3) a glucuronide fraction. Sulfate and glucuronide fraction, respectively, are each subjected to a second run for separation into their three components. Thus, the following conjugates have been prepared: 4-hydroxy-antipyrine sulfate, norantipyrine sulfate, 4,4'-dihydroxy-antipyrine sulfate, and 4-hydroxy-antipyrine glucuronide, norantipyrine glucuronide, 3-hydroxymethyl-antipyrine glucuronide. Methodology is also applicable to bile fluid and liver perfusate. Stability of isolated conjugates against acid hydrolysis has been studied to show that strongly marked differences exist in this series of conjugates. Field desorption mass spectrometry has been used for the direct identification of intact conjugates in an underivatized form. Using 13C-NMR, the structure of norantipyrine glucuronide has been established as an 5-enol glucuronide. By analogy, a structure of 5-enol sulfate is proposed for norantipyrine sulfate. From a semiquantitative examination by TLC of urine extracts from man and rat, it becomes apparent, that in the rat, at the dose level studied, sulfate formation is the predominant conjugation pathway. In man, glucuronides are the most prominent type of conjugates. Formation of sulfates is minimal up to a dose of 15 mg/kg antipyrine.

Adult↗

Quantitation and urinary pattern of 4,4'-dihydroxy-antipyrine, 4-hydroxy-antipyrine and 3-hydroxymethyl-antipyrine, as main metabolites of antipyrine in man and rat.

A t.l.c.-assay has been developed for the simultaneous determination from the urine of man and animals of three major hydroxylated metabolites of antipyrine (4,4'-dihydroxy-antipyrine, 4-hydroxy-antipyrine, 3-hydroxymethyl-antipyrine). The methodology is also applicable to bile fluid, liver perfusate and liver homogenate. Genuine conjugates are cleaved by acid hydrolysis and free, acid stable metabolites are extracted. Extracts are subjected to t.l.c. and the chromatograms analysed quantitatively by u.v.-reflectance measurements using authentic materials as standards. Calibration curves are linear with a correlation coefficient r greater than 0.990. Recovery for each metabolite is greater than 95%. Reproducibility of the method is good, with variation coefficients in the range of 3-7%, depending on concentration. The sensitivity of the method is sufficient for practical needs. The specificity of the procedure was confirmed using radio-labelled antipyrine. In man, 4-hydroxy-antipyrine is the principal hydroxylation product in this series, accounting for about 35-40% of the dose. 3-Hydroxymethyl-antipyrine makes up for about 13-17% and 4,4'-dihydroxy-antipyrine represents 3-6% of the dose of antipyrine. In the rat, 4-hydroxy-antipyrine accounts for about 15-31%, 3-hydroxymethyl-antipyrine for 22-28% and 4,4'-dihydroxy-antipyrine for up to 11-18% of the dose. Variation of this pattern in different strains is moderate. In both species, the major portion of phase-I metabolites is excreted as conjugates. Part of them appears in a free form.

Adult↗