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Biomedical subjects

S Nolte

Publications and source records attributed to S Nolte.

18 recordsLinked to original sources
PubMed2006

[Presbyopia treatment using a femtosecond laser].

Presbyopia is by far the most common refractive error worldwide, with no permanent therapeutic option available. All efforts to restore accommodation by the use of surgery have not led to a generally accepted therapy. However, there is evidence from an animal model that the use of a femtosecond (fs) laser might influence the modulus of elasticity in the lens. Fs-laser impulses can create intralenticular disruption in animal eyes as well as human cadaver lenses and improve elasticity. The concept of treating presbyopia with fs-laser requires a new, complex theory combining the optical and the mechanical aspects of accommodation in the eye. Diagnostic tools for measuring optical change in power and geometrical modification as the eye views from far to near are needed to obtain objective clinical data. A non-invasive treatment of presbyopia to restore accommodation might be possible in the future.

Accommodation, Ocular↗
PubMed2004

Amphetamines for schizophrenia.

BACKGROUND: It is estimated that between 10% and 65% of people with schizophrenia use illicit drugs such as amphetamines. This group have an increased rate of hospitalisation, homelessness, unemployment and suicide compared with those with schizophrenia who do not abuse drugs. OBJECTIVES: To evaluate the effects of amphetamines for people with schizophrenia in terms of clinically meaningful outcomes, cognitive functioning and physiological tests. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group's Register (February 2002). SELECTION CRITERIA: We included all randomised controlled trials investigating the effects of amphetamines on people with schizophrenia, compared with a placebo intervention. DATA COLLECTION AND ANALYSIS: Working independently, we selected and critically appraised studies, extracted data and analysed on an intention-to-treat basis. Where possible and appropriate we calculated risk ratios (RR) and their 95% confidence intervals (CI), with the number needed to treat (NNT). For continuous data we calculated Weighted Mean Differences (WMD). MAIN RESULTS: We included four short studies with a total of 83 participants. Data were few and poorly reported. The results indicated a reduction of negative symptoms for people allocated to amphetamines (n = 16, 1 RCT, WMD -3 CI -5.02 to -0.98). No such effect was found for positive symptom change (n = 16, 1 RCT, WMD 0 CI -4.46 to 4.46). Compared with placebo, amphetamines significantly increased metabolism in the left and right cerebellum (n = 23, 1 RCT, WMD 0.12 CI 0.06 to 0.18; n = 23 1 RCT, WMD 0.12 CI 0.06 to 0.18) and left striatum (n = 23, 1 RCT, WMD 0.14 CI 0.00 to 0.28) and also significantly decreased metabolism in the left dorsolateral prefrontal cortex (n = 23, 1 RCT, WMD -0.09 CI -0.17 to -0.01). REVIEWERS' CONCLUSIONS: Understandably amphetamines are rarely formally evaluated in randomised studies and therefore unpublished work in this area is likely to exist. Addition of more studies may clarify reasons why people with schizophrenia persist in taking these harmful stimulants.

Amphetamine-Related Disorders↗
PubMed1992

Telephone counseling improves adherence to colposcopy among lower-income minority women.

PURPOSE: A randomized trial was conducted to evaluate the impact of a telephone counseling intervention to improve patient adherence to colposcopic examination for suspected cervical intraepithelial neoplasia (CIN). METHODS: Subjects were lower-income, minority women who missed a scheduled initial appointment for colposcopy at an urban medical clinic. Patients were randomly assigned to either a control condition (n = 42) or a telephone counseling condition (n = 48). The 15-minute, structured telephone counseling intervention protocol addressed educational, psychosocial, and practical barriers to colposcopy adherence. RESULTS: The most common patient-reported barriers to colposcopy adherence included a lack of understanding of the purpose of colposcopy (50%), worry about or fear of cancer (25%), and forgetting (23%). Telephone counseling was found to be highly effective in addressing these barriers and improving adherence to diagnostic follow-up and treatment. Of patients in the control condition, 43% complied with a rescheduled colposcopy appointment, compared with 67% in the telephone counseling condition. Logistic regression analysis indicated that the effect of telephone counseling was independent of sociodemographic confounder variables (odds ratio = 2.6; P less than .003). Additionally, 74% of patients who received the initial telephone counseling adhered to recommended treatment, compared with 53% of patients in the control condition. CONCLUSION: Brief, structured telephone contact may be a cost-effective mechanism for improving adherence to diagnostic follow-up and treatment for a variety of cancer screening tests.

Adolescent↗
PubMed1991

Serum alpha 1-microglobulin and beta 2-microglobulin for the estimation of fetal glomerular renal function.

As proteins cannot cross the placenta levels of the microproteins alpha 1-microglobulin (alpha 1MG) and beta 2-microglobulin (beta 2 MG) can be used to assess fetal glomerular renal function. alpha 1MG, beta 2MG and creatinine were routinely determined in cord and maternal blood of 133 newborns [gestational age (GA) 25-42 weeks]. Twenty-nine patients with suspected impaired maternal or fetal renal function were studied separately and two fetuses were studied in utero. The mean fetal beta 2MG concentration fell from 3.87 +/- 0.56 mg/l in the 25-31 weeks GA group to 2.60 +/- 0.50 mg/l in the mature newborn group. alpha 1MG concentration fell from 3.10 +/- 0.51 to 2.25 +/- 0.49 mg/dl. In contrast, the mean maternal beta 1MG concentration rose from 1.73 +/- 0.69 mg/l in the 25-31 weeks GA group to a mean of 1.83 +/- 0.48 mg/l in the mature newborn group; alpha 1MG rose from 3.96 +/- 0.58 to 4.33 +/- 1.6 mg/dl. Maternal and fetal creatinine levels were identical. Fetal microprotein levels fall during intra-uterine development as glomerular filtration rate (GFR) rises. There is no correlation between cord blood and maternal alpha 1MG or beta 2MG concentrations. In 13 children with urological anomalies only 1 had elevated microprotein levels and he later developed renal insufficiency. Determination of microprotein levels in fetal serum can be used to detect severe renal function disturbances and to estimate GFR independently of maternal renal function.

Alpha-Globulins↗
PubMed1991

Adverse psychologic consequences of positive cytologic cervical screening.

Cervical cancer is still widely prevalent in the female population. This study explores the relationship of cervical cancer screening, positive versus negative Papanicolaou's test results, and psychologic status among lower-income minority women. All patients were interviewed 3 months after they had received initial test results. One hundred six women with normal Papanicolaou's test results were compared with 118 women who were referred for colposcopic examination for follow-up of positive test results. Women with positive Papanicolaou's-test results showed statistically significant elevations in worries about cancer and impairments in mood, daily activities, sexual interest, and sleep patterns. More fine-grained analyses revealed that the effects of positive results were most pronounced among those women who did not comply with colposcopy (n = 53). These findings suggest that lack of compliance with follow-up may maintain high levels of uncertainty about disease and may interfere with successful psychologic adaptation. Health education targeted to psychologically vulnerable individuals may reduce psychologic distress and enhance compliance.

Adolescent↗
PubMed1990

Intraepithelial neoplasia of the lower genital tract.

The incidence of CIN, VIN, and VAIN has increased dramatically in recent years due to a true increase in disease incidence as well as improved screening methods. Associated high-risk factors in the development of intraepithelial neoplasia are known, and effective treatment modalities are available. With the use of diagnostic techniques, patient education, and selection and utilization of appropriate therapies, intraepithelial neoplasia of the lower genital tract remains a disease that should not affect long-term morbidity, social status, or mortality of female patients.

Carcinoma in Situ↗
PubMed1989

[Evolutionary biological aspects of the physiology of extracorporeal CO2 removal].

Extracorporeal CO2 elimination (ECCO2-R) is a new approach to the treatment of severe respiratory failure. Gas exchange is separated into oxygen uptake by apneic oxygenation through the natural lungs while CO2 is removed extracorporeally with an artificial organ. The physiological conditions of both processes can thus be optimized. In the course of evolution, a similar bimodal gas exchange has developed during the respiratory transition from aquatic gas exchange to pulmonary gas exchange: In air-breathing fish or amphibia oxygenation is accomplished predominantly via the lungs while CO2 is eliminated via gill or skin. Today's air-breathing vertebrates maintain a considerable respiratory acidosis which has to be compensated for by an appropriate bicarbonate level. This is dependent upon gill reduction and skin armor to prevent evaporation leading to a rise in pCO2 from 3-4 to 40 mmHg and a tenfold increase of serum bicarbonate levels. We believe that the developmental history of respiration justifies the use of a bimodal gas exchange system. It is clinically applied as extracorporeal CO2 removal with membrane lungs (ECCO2-R) or, still under investigation, in a hemodialysis-related procedure (extracorporeal bicarbonate/CO2 removal: ECBicCO2).

Animals↗
PubMed1987

[Lymph drainage of the cornea, limbus and conjunctiva].

Air (n = 30), patent blue (n = 30), Berlin blue (n = 30), Berlin blue and air (n = 30), and Berlin blue and Mercox (n = 30) were injected into the corneas and conjunctivas of 150 enucleated cattle eyes. Using air for injection, so-called Bowman "corneal tubes" form in the cornea, which can easily be filled with pigment (patent blue, Berlin blue). In some cases (n = 3) the conjunctival lymphatics were filled with air during injection into the cornea. Besides the "corneal tubes", larger vessel-like structures can be demonstrated, which seem to be connected to corneal nerves. The significance of these structures as prelymphatics and their importance in the lymph drainage of the cornea are discussed. The injection of patent blue and Berlin blue into the limbus leads to the formation of a delicate network of arch-shaped lymphatics, from which larger lymphatics take their color. In the case of Berlin blue and Mercox, and Berlin blue and air injection, sections of lymphatic vessels in the shape of pointed arches form at the edges of the segments. It can be shown stereomicroscopically that these are not valves or invaginations, but only hump-shaped diverticula of the vessels. Annular constrictions of the lymphatic vessels were found, rather than bicuspid valves. The valveless pump mechanism described by Liebau is discussed as a possible means of lymph transport in the conjunctiva.

Animals↗
PubMed1987

Mechanically induced ventricular extrasystoles in the isolated perfused guinea-pig heart. A model to study cardiac arrhythmia and to differentiate antiarrhythmic drugs.

Pressure pulses applied to an isolated perfused guinea-pig heart via underwater hydrodynamic pressure waves during early diastole induce ventricular extrasystoles (VES). Intensity of pulse pressure and number of VES in relation to number of stimuli show a narrow and reproducible relation following a sigmoid function. Thus we were able to establish a pressure dose-response function between hydrodynamic peak pressure and percentage of VES-responses to mechanical stimulation. In overriding the natural heart rate a ventricular rhythm can be maintained for several hours. In the hypoxic or anoxic heart repetitive automatism can be induced by pulse pressure stimulus. In severe ischemia ventricular fibrillation may occur. In this model differentiation between various classes of antiarrhythmic drugs seems possible in setting up pressure dose-response curves for different concentrations of these drugs. The inhibition of VES is limited to class I antiarrhythmic drugs (quinidine, lidocaine) while specific Ca-antagonists (class IV) are ineffective, thus showing that induction of VES is mediated by a Na channel-dependent process. Preliminary data show that these results can be extended to in situ experiments using an external mechanical stimulator.

Animals↗
PubMed1987

[Terminal renal failure caused by interstitial nephritis following mushroom poisoning by Cortinarius speciocissimus].

A 14 year old boy was admitted for vomiting, anorexia, flank pain and leukocyturia/hematuria. Shortly after admission, he developed anuria and acute renal failure so that hemodialysis had to be started. Pre- and post-renal causes were excluded. There were no signs of acute glomerulonephritis; liver enzymes were normal. The 123Iodine-Hippuran scan showed a shock kidney pattern lacking tubular clearance. Renal biopsy revealed an interstitial nephritis with edema and a mixed cellular infiltration. History was empty for nephrotoxic agents except for mushroom ingestion: Five days before admission the boy ate Cortinarius speciocissimus mushrooms, the toxine of which is known to be nephrotoxic, causing irreversible renal failure in severe cases (Orellanus Syndrome). Renal function did not improve much and renal transplantation was performed after 14 months on hemodialysis. In interstitial nephritis of unknown etiology the possibility of mushroom poisoning should be considered.

Adolescent↗
PubMed1986

[Beta 2 microglobulin in the serum as a parameter of glomerular kidney function in the first days of life].

Though serum creatinine is a very reliable parameter for predicting glomerular filtration rate in infancy, this does not apply to the first hours and days of life. As there is no placental barrier for creatinine, serum creatinine at birth reflects maternal renal function at the moment of delivery and, during the first days of life, establishment of the steady state condition between creatinine serum level and actual infantile glomerular filtration rate. Serum creatinine levels of cord blood and maternal blood in term and preterm infants of 25-42 weeks gestational age are almost identical (maternal blood 0.82 +/- 0.34 mg-%, cord blood 0.87 +/- 0.34 mg-%, n = 77, r = 0.94), whereas there is no correlation between maternal and infantile beta 2-microglobulin concentrations (maternal blood 2.1 + 1 mg/1, cord blood 3.3 +/- 0.6 mg/l, n = 78, r = 0.05). There is no free diaplacental exchange for this low molecular weight protein. The determination of cord blood beta 2-microglobulin levels therefore predicts the newborn's renal function independently of the mother's. It is possible to differentiate between prenatal and perinatal genesis of renal damage in case of renal failure in the newborn, and to study the elimination of creatinine preloading in maternal renal insufficiency. Although we are not yet able to give an exact quantitative prediction of glomerular filtration rate by determining beta 2-microglobulin we believe it to be the best parameter of glomerular renal function in this age-group.

Creatinine↗
PubMedDate not supplied

[Respiratory death space and ventilation of newborn infants].

The effect of dead space reduction was studied in 10 VLBW infants (GA 26-31 wks, mean BW 1100 grms) on mechanical ventilation using a constant flow ventilator with a flow sensor device (Draeger Babylog 8000, Lubeck, Germany). Shortening of the endotracheal tube and removal of the flow sensor resulted in a calculated 50% reduction of dead space (-2.3 ml) and in a fall of tcpCO2 from (mean and range) 45 (40-49) to 35 (31-36) mmHG. This corresponds to a increase of alveolar ventilation of 22% as predicted by calculation of the dead space changes. Further attempts were made in reducing dead space ventilation by using endotracheal tubes conceived for jet ventilation, using the jet entry for the inspiratory side, or by introducing a separate continuous inspiratory flow to the tip of the endotracheal tube. Besides a routinely performed shortening of the ET tube this means of ventilation was used with success in two VLBW infants with desperate respiratory situations who both survived, in an older infant with high-grade tracheal stenosis to wean him from the respirator and in three neonates with congenital diaphragmatic hernia in conjunction with delayed operative repair who could be weaned from respiratory support 4, 13 and 20 days post surgery. We conclude that dead space reduction is a means to achieve gentle ventilation and to reduce lung damage from artificial ventilation.

Airway Resistance↗
PubMedDate not supplied

Prevention of HIV infection in women.

The number of HIV-infected women in the United States has continued to rise. Although risk-reducing behaviors such as condom use, partner selection, partner reduction, and safe sex practices have been identified, women continue to engage in high-risk activities. Nurses need to offer testing for HIV infection to all women. Education programs directed at the transmission and prevention of HIV infection also are needed. This article describes nursing strategies designed to incorporate primary, secondary, and tertiary prevention of HIV infection in women.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Assessment of fetal kidney function by determining the microprotein levels (alpha-1 and beta-2 microglobulin) in fetal blood].

Fetal renal function cannot be assessed with clearance methods. Fetal urea and creatinine serum levels correspond to maternal values, the fetus being hemodialyzed by his mother till birth. To predict glomerular filtration independently of maternal renal function, levels of alpha 1-microglobulin (MG) and beta 2MG and creatinine were routinely determined in cord blood of 375 newborns (GA 25.-42 weeks) in cord blood and in 154 cases in corresponding maternal blood samples. alpha 1MG was determined in a radial immunodiffusion method, beta 2MG by radioimmunoassay, creatinine enzymatically. The mean alpha 1MG concentration fell from 3.1 mg/dl in 25-31 weeks prematures to 2.3 mg/dl in 38-42 week group (p less than 0.005), beta 2MG concentration fell from 3.9 mg/l to a mean of 2.6 mg/l (p less than 0.0005), while in maternal blood, levels rose from 4.0 to 4.3 mg/dl (alpha 1MG) and from 1.7 to 1.8 mg/l (beta 2MG) (n.s.). Creatinine levels rose from 0.63 to 0.75 mg/dl in both fetal and maternal blood. Parallel to the rise in GFR, microprotein levels fall during intrauterine development, while maternal serum levels increase. There is no correlation between maternal and cord blood alpha 1MG or beta 2MG concentrations. This is distinct in cases with severe maternal or fetal renal insufficiency (n = 10). Thus microprotein determination in fetal serum can be used to detect severe renal function disturbances and to estimate glomerular filtration rate independently of maternal renal function.

Alpha-Globulins↗