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Biomedical subjects

S Lowens

Publications and source records attributed to S Lowens.

8 recordsLinked to original sources
PubMed2006

[Anesthesiological management of neuroendovascular interventions].

The endovascular treatment of diseases of intracranial and spinal vessels has become widely accepted in recent years. The patient is usually treated under general anesthesia and in choosing an appropriate anesthesia regimen and an optimized pre-interventional preparation, the anesthesiologist can influence the postinterventional result. The working environment in the angiography suite should address the requirements of a routine procedure and the necessities of complication management. Application of short-acting narcotics and relaxation of the patient if required, facilitate the intervention for both the neuroradiologist and the anesthesiologist. The patient should be supplied with everything needed before the intervention to avoid any waste of time in the case of an emergency (e.g., haemorrhage or fibrinolytic treatment). After the procedure the patient has to be monitored for at least 24 h. Peri-interventional and postinterventional complications, such as thrombo-embolism or hemorrhage, must be managed aggressively and consequently by the anesthesist to improve the postinterventional outcome. Therefore a close collaboration between the anesthesiologist and the neuroradiologist is essential.

Anesthesia↗
PubMed2005

Treatment of intracranial atherosclerotic stenoses with balloon dilatation and self-expanding stent deployment (WingSpan).

The endovascular treatment of atherosclerotic intracranial arterial stenoses has previously been based on balloon dilatation or the deployment of a balloon expandable stent. Both methods have advantages (balloon: flexibility; balloon expandable stent: high radial force) and drawbacks (balloon: risk of elastic recoil and dissection; balloon expandable stent: limited flexibility, risk of injury to the vessel due to excessive straightening, overexpansion at ends of stent). A new combination of balloon dilatation, followed by the deployment of a self-expanding microstent has been applied in 15 patients with atherosclerotic arterial stenoses, symptomatic despite medical treatment. An anatomically and clinically adequate result was achieved in all patients. The initial degree of stenosis was 72% (mean). Balloon dilatation resulted in an average residual stenosis of 54% (mean), reduced further to a mean of 38% after stent deployment. Arterial dissection, occlusion of the target artery or symptomatic distal emboli was not encountered. In one patient, a side branch occlusion occurred after dilatation of a M1 stenosis, with complete neurological recovery. All patients were either stable or improved 4 weeks after the treatment. Recurrent TIA did not occur in any patient. Balloon dilatation and subsequent deployment of a self-expandable stent for the treatment of symptomatic intracranial arterial stenoses combines the advantages of both techniques and allows a rapid, clinically effective and technically safe treatment of these frequently challenging lesions.

Aged↗
PubMed2001

Clinically silent circulating microemboli in 20 patients with carotid or vertebral artery dissection.

BACKGROUND AND PURPOSE: Carotid and vertebral artery dissections are frequently complicated by cerebral embolism. Detection of clinically silent circulating microemboli by transcranial Doppler sonography (TCD) is now widely investigated in patients with carotid artery disease in the hope to identify patients at increased risk for stroke. METHODS: In 20 patients with carotid (n = 17) or vertebral (n = 2) artery dissection, or both (n = 1), we performed a 1-hour microembolus detection downstream to the dissection in the middle or in the posterior cerebral artery, respectively. RESULTS: Five patients with a carotid artery stenosis of > or = 90% or with carotid artery occlusion showed microembolic signals at a rate of up to 15 events/h. In all these patients, the onset of the dissection was within the last 58 days. Patients with lower degrees of stenosis or onset of symptoms beyond 58 days did not show microembolic signals at all. Three patients who had presented with recurrent ischaemic events prior to TCD monitoring unexceptionally had microembolic signals. CONCLUSION: Microembolic signals occur in patients with high-grade stenosis or occlusion due to acute cervical artery dissection. Patients with microemboli seem to be at increased macroembolic risk, i.e. stroke recurrence, and may require close-meshed clinical follow-up and possibly stronger antithrombotic treatment.

Adult↗
PubMed2000

[Need for psychosocial nursing care in a psychogeriatric nursing home].

The aim of this study is to analyze the dimensions of psychosocial nursing requirements in a psychogeriatric nursing home. In addition to biographical and anamnestical data of nursing home residents, the psychosocial nursing requirements are measured with the Nurses' Observations Scale for Geriatric Patients (NOSGER). Data are compared with patients of a psychogeriatric department of a state psychiatric hospital. Results show that psychogeriatric nursing home residents have at least as much psychosocial restrictions as acutely mentally ill patients in the psychiatric hospital. In some dimensions of the NOSGER (memory, social behavior) residents show even higher scores than the control group. By analyzing the rate of residents and psychogeriatric patients who score above the cut-off points given by the NOSGER developers, it is shown that the rate of residents with psychosocial nursing requirements is at least as high as in the control group. Concerning the NOSGER dimensions Instrumental Activities of Daily Living and Social Behavior, the rate of nursing home residents above the cut-off points is significantly greater than the rate of the acute psychogeriatric patients. It is concluded that budgets of psychogeriatric nursing homes must be able to finance qualified psychiatric personnel to meet the residents' special psychosocial requirements adequately.

Activities of Daily Living↗
PubMed2000

[Homeless men in inpatient psychiatric treatment--a controlled study. 1: Health status and self assessment at intake].

OBJECTIVE: This study examines the objective and the subjectively reported state of health, the social network and the utilisation of mental health services in a representative group of homeless men (n = 50) at time of admission to a psychiatric hospital and compares these results with a control group (matched by diagnosis) of non-homeless men. METHOD AND PATIENTS: The BPRS, the SF-12 Health Survey and a neglection index were administered. The main psychiatric diagnosis (ICD-10) were alcohol addiction (n = 29), drug addiction (n = 13), schizophrenia (n = 7) or personality disorder (n = 1). RESULTS: No differences were found according to sociodemographic basis data, but the homeless group had a smaller social network and less financial resources. There was a higher rate of involuntary admission in the homeless group, less contact to mental health services in the weeks before admission, more psychopathological symptoms and more physical neglection. Self-rating of mental and physical health, however, did not differ significantly. There was a positive correlation between thought disturbance and positive self-rating of mental health. CONCLUSION: The mental and physical health of the homeless patients was markedly worse. Beneath structural barriers symptoms, the extreme distress of their living situation and the decreased insight and motivation for treatment are characteristics of this group of patients which make them difficult to treat.

Adolescent↗
PubMed2000

[Homeless men in inpatient psychiatric treatment--a controlled study. 2: Effects of treatment].

OBJECTIVE: This study examines the objective and the subjectively reported state of health in a regional representative sample of homeless men (n = 50) at time of admission into a psychiatric hospital and shortly before discharge and compares the results with a control group (matched by diagnosis) of non-homeless men. METHOD AND PATIENTS: The BPRS and the SF-12 Health survey were administered. The main psychiatric diagnosis (ICD-10) were alcohol or drug addiction (84%), schizophrenic disorders (14%) and personality disorders (2%). RESULTS: The median of hospitalisation was 26 days with no significant differences between the two groups. At discharge outpatient treatment was planned for only 16% of the homeless patients but for 40% of the controls. There was a significant improvement in symptoms and self reported state of health. On admission and discharge thought disturbance and a positive self-rating of mental health were significantly correlated. CONCLUSIONS: Against the wide-spread clinical prejudice that inpatient treatment of homeless mentally ill men is not effective our results show that the objective state of health as well as the self-perceived mental and physical health was improved by a regular psychiatric in-patient treatment. The results furthermore indicate the limitations of inpatient treatment the need for outpatient treatment programmes.

Adolescent↗