[Research--publications--impact factor--"industry-method" corruption. Thoughts on a German phenomenon].
Explore the source record for details and available documents.
Bibliometrics↗
Biomedical subjects
W Dick
Publications and source records attributed to W Dick.
Total hip arthroplasty after arthrodesis of the hip joint.
The results of 15 conversions of a hip arthrodesis into a total hip arthroplasty performed in the years 1980-1995 are reported. Fifteen patients (8 men, 7 women) underwent total hip arthroplasty 30.9 (range 2-61) years after spontaneous or operative fusion of a hip joint. The primary indications of the conversion were low-back pain (n = 10), knee pain (n = 2) and hip problems (n = 3). At follow-up examination 5.4 (range 2-13.3) years postoperatively, the Harris Hip Score averaged 86.0 (range 70.1-99.0). Six patients were pain-free, 7 had less pain, 2 felt no improvement of pain. All patients confirmed that they would undergo the operation again. The Trendelenburg sign was negative or mild in 8 patients and moderate to severe in 7. Aseptic loosening of 2 stems (1 cemented, 1 cementless) and 2 deep infections required revision surgery. We conclude that this operation can lead to satisfactory results even after a long duration of the arthrodesis. However, full function with no pain and a negative Trendelenburg sign could be obtained in only 20% (3/15) of the cases.
Adult↗
Ventilation volumes with different self-inflating bags with reference to the ERC guidelines for airway management: comparison of two compression techniques.
The 1998 ERC-guidelines for airway-management recommend an tidal volume of 400-600 ml for adults undergoing CPR. As commercially available self-inflating bags were designed to meet former recommendations (800-1200 ml) we investigated how to meet the latest recommendations with these bags. We combined the head of a training manikin (Laerdal Medical) and a standard lung (VTTL; Michigan Instrument), adjusted to a physiological compliance and resistance. Volume was measured with a Wright spirometer (BOC). Seven self-inflating bags were investigated. Tests were carried out by ten people (five female and five male) for 5 min each using two different techniques. Technique 1: standard ventilation with one hand without compression of the self-inflating bag against the rescuers knee. Technique 2: modified open palm technique with total squeezing of the self-inflating bag by compression against the rescuers knee. The average tidal volumes for technique 1 ranged from 438 to 604 ml. Applying technique 2 the volumes ranged from 888 to 1192 ml. The latest recommendations were met using a single hand technique without compression against the rescuers knee for all seven bags tested. The modified open palm technique produced larger tidal volumes which were more in line with previous recommendations.
Cardiopulmonary Resuscitation↗
Alternative methods of mechanical cardiopulmonary resuscitation.
Due to the relative ineffectiveness of standard resuscitation techniques, alternative methods have been explored for many years. The aim of new methods is to improve haemodynamics and increase survival rates. In spite of some encouraging haemodynamic results, all but one study failed to show an increase in long-term survival rates with an alternative method in a convincingly large group of patients (hospital discharge without neurological damage, and 1-year survival). In this study active compression-decompression resuscitation (ACD-CPR) increased long-term survival compared to standard-CPR. The results from certain individual studies, which showed a significant increase in short-term survival rate, could not be reproduced in other trials. This may be attributed in part to the fact that the alternative methods are not significantly superior, but also due to logistical and statistical problems in the conduct of the studies and differences in application within and between the study sites. ACD-CPR has been the most studied method amongst the alternatives and can be recommended for patients with asystole in centres with special training and where outcome quality is regularly verified and evaluated.
Animals↗
Morton's intermetatarsal neuroma: morphology and histological substrate.
Twenty-three biopsies from patients with the typical symptoms of intermetatarsal neuroma (so-called Morton's metatarsalgia) were compared histologically and semi-quantitatively with 25 plantar nerves from the intermetatarsal space III/IV gained at autopsies from cases where no problems in the forefoot had been recorded. The histomorphological examination of the nerves from autopsies revealed the same findings as were found in the biopsies. Thus, qualitatively, the nerves from patients could not be distinguished from those gained at autopsy. The only difference was the diameter of the resected nerves: semi-quantitative analysis of the nerves showed that the 17 thinnest ones were all from autopsies and the five thickest ones from biopsies of symptomatic patients. At medium diameters, however, there was wide overlap of the two groups. The study yielded a specificity of the swelling of 80 % and a sensitivity of 78%. From these results it must be concluded that diagnostic MRIs or ultrasonography, are unnecessary for decision-making about operative treatment and are not superior to exploratory local anaesthesia. Since histomorphological findings in intermetatarsal neuroma (so far accepted as the gold standard for confirmation of that diagnosis) were the same as findings in autopsied (normal) specimens, the value of postoperative histological examination is questioned. It merely proved that the nerve has been resected.
Adult↗
No influence of osteoarthritis of the hand on phalangeal osteography in elderly women.
We investigate the influence of hand osteoarthritis on skeletal quantitative ultrasound (QUS) measurement through the proximal phalanges in female geriatric inpatients. In a cross-sectional study, bone status was assessed with QUS at the distal metaphysis of the first phalanges of fingers II-V. Thirty-three of 101 female geriatric inpatients met the clinical criteria of the American College of Rheumatology for osteoarthritis of the hands (median age: 85 years) and were compared to 68 female inpatients without swellings of the small finger joints (median age: 88 years). Amplitude-dependent speed of sound at the distal metaphysis, the electronic signal of the ultrasonic wave after crossing the phalanx (graphic trace), and the thickness of the each phalanx were measured and compared between the two groups by a phalangeal QUS device (DBM-Sonic 1200). There were no significant differences between the phalangeal QUS readings of both groups. The only statistically significant difference was observed in the comparison of the small finger thickness with a lower value in the osteoarthritis group (p = 0.02). These findings suggest that at the metaphyseal level of phalanges, the degenerative process of osteoarthritis doesn't influence the QUS assessment. This could be explained by the finger thickness at metaphyseal level, which was not increased in patients with osteoarthritis compared with control subjects, at least as detected by the applied finger ultrasound method.
Aged↗
[Hemodynamic effects of a ventriculo-cisternal perfusion of bupivacaine].
OBJECTIVES: The cardiotoxic properties of bupivacain have been well documented under in-vitro, as well as under in-vivo conditions. A further mechanism of cardiovascular impairment by bupivacaine via the central nervous system gained investigational interest in animal studies. The aim of our study was to demonstrate the effect of a ventriculocisternal perfusion of bupivacain on systemic hemodynamic variables and their reversibility by wash-out with mock-CSF. METHODS: After obtaining animal investional committee consent, nine anaesthetized and relaxed pigs were prepared for a ventriculocisternal perfusion (VCP). Hemodynamic data were obtained by invasive blood pressure measurements in the high and low pressure system as well as cardiac output (thermodilution technique), intracranial pressure and electrocardiogram. Systemic vascular resistance and stroke volume were calculated using standard formulas. A second group of three animals were exposed to an intravenous infusion of the same dose of bupivacain over the same period of time to rule out direct cardiac effects. After instrumentation baseline data were obtained (K0 1) under VCP with mock-CSF for 30 minutes. The mock-CSF was replaced by 0.05% bupivacaine in mock-CSF and VCP was continued with 3 ml.h-1 for 20 minutes. After administration of 500 micrograms bupivacaine data were collected (BU). The bupivacaine solution was replaced by mock-CSF and after twenty minutes hemodynamic measurement were repeated (K02). RESULTS: The intravenous administration of 500 micrograms bupivacaine had no effect on all measured variables. VCP of the same dose resulted in significant increase in heart rate, systolic, diastolic and mean arterial blood pressures. Left and right heart filling pressures as well as systemic vascular resistance were not affected while the stroke volume decreased. After continuation of VCP with mock-CSF hemodynamic changes were reversed. DISCUSSION: Our results demonstrate that bupivacaine initiates an indirect cardiovascular stimulating effect of a VCP with 500 micrograms of bupivacaine via the central nervous system. The intravenous administration of the same dose had no effect. The centrally mediated cardiovascular effect of bupivacaine was reversed by wash-out with mock-CSF. The cardiovascular stimulation observed in this animal experiment may be of clinical relevance as a potential sign of toxic effects of bupivacaine on the CNS.
Anesthetics, Local↗
Pharmacokinetics and pharmacodynamics of hydroxyethyl starch in hypovolemic pigs; a comparison of peripheral and intraosseous infusion.
Intraosseous (i.o.) infusion is considered a useful technique for the administration of medications and fluids in emergency situations when peripheral intravascular access is not possible. This study investigated the effectiveness of i.o. versus intravenous (i.v.) infusion of hydroxyethyl starch (HES 200/0.5) in hypovolemic pigs. Twenty-three pigs (8- to 9-week-old) were anaesthesized, instrumented and blood was withdrawn (25-30 ml/kg) to < 50 mmHg mean arterial pressure (MAP). The animals were left untreated in haemorrhage for 30 min. Relevant haemodynamic parameters were monitored and blood samples were collected for blood gas and HES concentration analysis. Infusion of HES via i.v. or i.o. line (20 ml/kg per h) carried out over a period of 30 min for volume resuscitation and measurements were taken every 5 min. Infusion was discontinued after 30 min and the animals were monitored for 1 h. Analysis of HES-pharmacokinetics and pharmacodynamics revealed no significant differences between i.o. and the i.v. administration. The results demonstrate i.o. infusion of HES to be a rapid and effective method for fluid resuscitation in hypovolemic shock.
Animals↗
Superior responsiveness of the pain and function sections of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as compared to the Lequesne-Algofunctional Index in patients with osteoarthritis of the lower extremities.
OBJECTIVE: To compare the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a questionnaire format of the Lequesne-Algofunctional Index in patients with OA of the lower extremities. METHODS: Longitudinal analysis of the instruments' responsiveness [standardized response mean (SRM), effect size (ES)] in ambulatory patients undergoing hip or knee arthroplasty. RESULTS: At six months 36, and at one year 40 out of 43 patients undergoing hip (N=30) or knee arthroplasty (N=13) could be examined. Both responsiveness statistics revealed the same order of responsiveness. For both indices and for both locations, the pain sections were more responsive than the function sections. However, the WOMAC scales and the WOMAC global index (hip at 12 months: SRM=2.4; knee at 12 months: SRM=2.0 ) were more responsive than the comparable Lequesne sections and Lequesne index (hip at 12 months: SRM=2.1; knee at 12 months: SRM=1.5). CONCLUSIONS: Although our results are based on a German version using a self-report format, the WOMAC scales appear to be more responsive than the Lequesne index in patients with OA of the lower extremities.
Adult↗
Stroke--a medical emergency.
Stroke is the third leading cause of death and number one cause of disability in industrialised countries. A number of new therapeutic approaches are currently in development for use in the acute phase of ischaemic stroke and all trials have, to date, demonstrated the importance of early diagnosis and subsequent initiation of treatment. It is well known that, for most patients, there is a long delay between the onset of symptoms and the start of treatment. A number of factors are responsible for this time delay: signs and symptoms often go unrecognised by patients, relatives, and bystanders and, unlike trauma or myocardial infarction, stroke is not given a high priority by medical staff. Studies into the pathophysiology of acute ischaemic stroke have indicated that treatment options are likely to be optimised when early signs of stroke are recognised and treatment is initiated within six hours of symptom onset. Although a small number of stroke patients are treated as emergencies and attended to by the emergency medical services within this time window, this number could easily be increased by intensified public and emergency personnel education. In the future, it is hoped that treatments which must be administered within the first few hours of acute stroke will be able to be initiated by the emergency medical services. In the same way that hospitals are notified and prepared in advance to receive trauma victims, early notification by the emergency medical services about stroke patients would enable stroke teams to be present at admission, thus improving the likelihood of a better outcome for patients.
Brain Ischemia↗
[High-frequency jet ventilation for placing tracheal stents--a case report].
Stenoses of the larynx and trachea may cause acute life-threatening situations. Surgical procedures in patients presenting this type of problem are a real challenge for the surgeon and the anaesthesiologist. Depending on the extent and the nature of the stenosis, the insertion of a stent may be the best therapeutic option. In this case, the high frequency jet ventilation offers certain advantages for the surgeon. Thanks to modern jet ventilators with automatic pressure monitoring and jet ventilation tubes with a separate lumen for pressure monitoring, the danger of barotrauma is considerably reduced, even in patients with a high-degree stenosis of the larynx and trachea. During insertion of a tracheal stent during jet ventilation, the complete cross-section of the trachea must at least be temporarily available to the surgeon. In addition, at the end of the operation the newly implanted stent should not be altered by manipulations necessary for artificial respiration. We describe a new method which uses tracheal jet ventilation for implanting a stent with only short interruptions of artificial ventilation. During recovery from anaesthesia, there is no risk of dislocating the newly placed stent.
Carcinoma, Adenoid Cystic↗
Can clinically relevant histamine release be accurately diagnosed in anaesthetised patients without plasma histamine measurements? Randomised study with nested sampling aimed to change paradigms.
Explore the source record for details and available documents.
Anaphylaxis↗
[Clinical studies on emergency medicine. An application oriented classification, its planning and realization].
Clinical studies are usually conceived of as controlled randomized trials, as retrospective patient statistics or as single case reports. However, such a classification is too narrow and overlooks many other forms of study designs. This review, therefore, offers a more encompassing and practical classification of clinical studies for the field of emergency medicine. Randomized controlled trials fulfill scientific criteria at the highest level (gold standard): comparison, repeatability, objective measurement. At the same time, randomized trials also have to comply with demanding ethical criteria and must be justifiable in the individual patient. Therefore, comparable uncertainty with regard to the superiority of the treatment options under investigation is a sine qua non. In addition to randomized trials, six other groups of clinical trials have the potential to solve scientific questions in emergency medicine: observational studies, decision analysis, meta analysis, public health care studies, case reports and descriptive summary statistics and studies on ethical problems. This variability in trial designs calls for a clinically oriented methodologist; the concept and institutionalization of theoretical surgery has been a response to this demand. All study types in this review are illustrated by examples in emergency medicine. Literature for advanced reading in particular trial methodologies can be found in the reference list. A checklist summarizes all elements for designing and conducting randomized trials in emergency medicine. All clinical trials striving for a high standard of quality--whether randomized or not--depend on the following prerequisites:professional organization, time effort, a supportive social environment and a scientific culture.
Clinical Trials as Topic↗
[Plasma concentrations of bupivacaine for continuous peridural anesthesia in children].
Epidural anaesthesia is extremely useful in providing postoperative analgesia for children after surgery of the lower body. Although results on early pharmacokinetics in children have previously been reported, no data are available on the long-term effects of epidural anaesthesia. The aim of this investigation was the assessment of plasma bupivacaine levels in children with continuous epidural anaesthesia in the postoperative period. A catheter with an outer diameter of 0.63 mm was inserted through a 19G Tuohy cannula into the epidural space. A maximum dose of 0.4 mg/kg/h bupivacaine was administered for continuous epidural infusion. Careful monitoring was performed to detect early signs of local anaesthetic intoxication. Two milliliters of blood were obtained in each patient per day and nepholometric serum measurement were performed to determine alpha 1-acid glycoprotein and albumin levels. Bupivacaine plasma concentrations were assessed according to the method described by Sattler et al. [25]. Ten children were included in the investigation. The measured albumin and alpha 1-acid glycoprotein concentrations were within the range described by other investigators. At the onset of pain therapy maximum levels of 0.5 microgram/ml were recorded after a loading dose of bupivacaine and levels of up to 2.2 micrograms/ml were achieved following continuous infusion. There were no neurologic complications or signs of local anesthetic intoxication. In conclusion our results show that a dose of up to 0.4 mg/kg/h bupivacaine during continuous epidural infusion is not associated with toxic complications. Careful monitoring of the children by experienced staff is mandatory.
Anesthesia, Epidural↗
[New aspects of electric defibrillation].
Early defibrillation is the standard of care for patients with ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Technical developments aim at further miniaturization and simplification of defibrillators as well as adaptation of energy requirements to the patient's needs. Implantable Cardioverter-Defibrillators (ICD) and automated external defibrillators (AED) are based upon the same technology. Both devices analyze the ECG signal internally, followed by a "shock" or "no shock" decision. Use of automated devices is the prerequisite for defibrillation by non-physicians. Chest impedance measurements and use of alternative shock waveforms, such as biphasic, aim at adaptation of energy or current to the patient's individual needs and avoid application of unnecessarily high amounts of energy to the myocardium. Calculation of median frequency is a non-invasive method for analyzing the heart's metabolic and electrical state. It helps to determine the optimal moment for defibrillation during cardiopulmonary resuscitation (CPR). Developments concerning the structure of in-hospital emergency systems or pre-hospital emergency medical services (EMS) aim at further reductions in time from collapse of a patient until first defibrillation. Such developments include early defibrillation programs for emergency medical technicians (EMT), nurses, and fire or police department first responders as well as wide distribution of easy-to-operate defibrillators in public areas, as discussed during the American Heart Association's Public Access Defibrillation conferences. All programs of that kind have to be organized and supervised by a physician who is responsible for training and supervision of the personnel involved.
Arrhythmias, Cardiac↗
[Continuing education as an instrument of medical quality management].
A rheumatologic educational program for general practitioners (GPs), based on andragogic principles, has been developed by the study group for Continuing Education and Quality Control of the Association of Cooperative Centers of Rheumatology in the DGRh. The educational program has been tested and evaluated by a study group supported by the German Ministry of Health (FB 2-43346-8/63) as an possible tool for quality assurance in rheumatology. Evaluation was carried out in 2 audit circles each of the KV Hessen and KV Lower Saxony. In the 4 audit circles 39 GPs and 3 trained rheumatologists, acting as "experts", participated. Using didactic materials provided by the study group, the topic "shoulder-neck pain" was discussed in all 4 audit circles. Questionnaires and case records according to the topic were used as evaluation tools. The evaluation was supported scientifically by the Scientific Institute of the German Medical Association (WIAD). Of patients with shoulder-neck pain (1193 pre- and 958 post-education) 2151 records were documented by the participating GPs for the evaluation of outcome in respect of changes of diagnostic and therapeutic attitude. Additionally pre- and postintervention, 10 MC questions related to the topic were used to measure changes in specific knowledge, and at the end of the audit circles participants were asked by questionnaire for acceptance of the educational program. An index of acceptance of 9.6 points (best: 7.0 points, worst: 31.0 points) indicating an excellent acceptance of the educational program by the participating GPs was recorded. The increase in specific knowledge amounted to about 30% in all 4 audit circles. Changes in diagnostic and therapeutic attitudes showed a better specification within the spectrum of diagnoses, a reduction of expensive and not indicated diagnostic procedures (e.g., CT), as well as a reduction in the use of non-adequate therapeutic modalities (e.g., massage, fango, unguenta, and gels) in favor of physiotherapy and mobilisation or local and systemic use of corticosteroids. The results of the evaluation project demonstrate that interactive learning in small groups (audit circles) based on andragogic principles can contribute to a better quality of care of patients with rheumatic diseases. The innovative concept seems to be a well-accepted alternative to formal lectures in postgraduate medical education.
Curriculum↗
High-dose epsilon-aminocaproic acid versus aprotinin: antifibrinolytic efficacy in first-time coronary operations.
BACKGROUND: The antifibrinolytic efficacy of a high-dose regimen of epsilon-aminocaproic acid (epsilon-ACA) was compared with aprotinin in first-time coronary operations. METHODS: In a prospective, double-blinded, randomized study, 20 patients received high-dose epsilon-ACA (10 g both as a loading and cardiopulmonary bypass priming dose, 2.5 g/h until 4 hours after protamine), and another 20 patients received aprotinin (2 x 10(6) KIU [280 mg] for loading and priming, 0.5 x 10(6) KIU/h [70 mg/h]). Ten untreated patients served as controls. RESULTS: Both agents reduced postoperative levels of thrombin/antithrombin III complexes, D-dimers, fibrin degradation products, free plasma hemoglobin (epsilon-ACA versus aprotinin, p = not significant; p < 0.05 versus controls), and amount of retransfused autologous blood (p < 0.001). Epsilon-ACA increased, aprotinin suppressed antiplasmin-plasmin complex generation (epsilon-ACA versus controls, p < 0.02; epsilon-ACA versus AP, p < 0.0001). For 4 hours after discontinuation, more chest drainage occurred with epsilon-ACA than aprotinin (137 +/- 90 mL versus 62 +/- 29 mL; means +/- standard deviation; p < 0.02). Cumulative 12-hour drainage was similar for aprotinin (391 +/- 220 mL) and epsilon-ACA (582 +/- 274 mL), but higher without inhibitor (1,091 +/- 541 mL; p < 0.001 versus drugs). Postoperatively, aprotinin was associated with the lowest autologous retransfusion incidence and highest hematocrits (p < 0.01 versus epsilon-ACA). Homologous transfusion exposures did not differ. CONCLUSIONS: In first-time coronary operations, higher postoperative hematocrit and less shed blood retransfusion constitute only subtle advantages of aprotinin over high-dose epsilon-ACA.
Aminocaproic Acid↗
The 1998 European Resuscitation Council guidelines for adult advanced life support: A statement from the Working Group on Advanced Life Support, and approved by the executive committee.
Explore the source record for details and available documents.
Adult↗