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Biomedical subjects

Wolfgang Lederer

Publications and source records attributed to Wolfgang Lederer.

15 recordsLinked to original sources
PubMed2006

Altered electrical activity of fibrillation process following thrombolytic therapy in out-of-hospital cardiac arrest patients with sustained ventricular fibrillation.

The likelihood of successful defibrillation in patients with sustained ventricular fibrillation (VF) is increased after administering thrombolytics during cardiopulmonary resuscitation (CPR). While dissolution of coronary artery thrombosis resolves the underlying cause of myocardial infarction in the majority of patients, improved microcirculatory reperfusion and alteration of the electrical activity of the fibrillation process may increase the likelihood of restoring spontaneous circulation in cardiac arrest patients. Electrocardiography is a sensitive means of displaying current myocardial perfusion in VF using changes in the frequency and amplitude of fibrillation. Our hypothesis postulates that thrombolytic therapy during CPR increases fibrillation frequency, fibrillation amplitude and amplitude spectrum area, thus improving ventricular fibrillation status and the chance of successful defibrillation.

Cardiopulmonary Resuscitation↗
PubMed2006

Review on the importance of an emergency kit for physicians in out-of-hospital emergencies.

The importance of an emergency kit for private use by emergency physicians was evaluated. Self-reporting questionnaires were used to assess the satisfaction of emergency physicians who were given a specially adjusted emergency kit for 3 years. Of 73 emergency physicians, 52.1% used the kit at least once during a 3-year interval. Physicians who already used the emergency kit responded more frequently to the importance of having private emergency equipment than those who did not. The kit's low weight and assortment of equipment including ventilation equipment were given higher ratings by users. The majority of physicians regarded a maintenance interval of 6-12 months as sufficient for the emergency equipment. In conclusion, the private emergency kit was used by more than half of the study participants at least once during a 3-year study period. Emergency physicians who used the emergency kit gave it higher ratings than did non-users.

Attitude of Health Personnel↗
PubMed2006

Changes in injury patterns and severity in a helicopter air-rescue system over a 6-year period.

OBJECTIVE: To study the influence of current trends in alpine sports on the frequency and types of injuries handled by a helicopter-based emergency medical system (HEMS) in a wilderness mountain region. METHODS: A retrospective review of medical reports at a single emergency helicopter port (Christophorus-1 air rescue) in Innsbruck, Austria, was conducted for comparison between two 3-year periods (1998-2000 and 2001-2003). RESULTS: Comparing the two 3-year periods, the proportion of leisure-time injuries leading to HEMS activation increased, whereas the frequency of life-threatening injuries significantly declined (P = .001). There was significant increase in injuries during mountain hiking and rock climbing (P = .002), during swimming (P = .013), and in avalanches (P = .019). Most injuries (70.1%) were recorded for skiers, and 68.3% involved tourists. During the investigation period, the high National Advisory Committee of Aeronautics scores showed a decreasing trend, whereas Glasgow Coma Scale scores and low National Advisory Committee of Aeronautics scores tended to increase (P = .048). CONCLUSIONS: For the HEMS in this study, there has been an increasing number of calls for help from persons involved in outdoor leisure activities. As the number of life-threatening injuries declines, HEMSs more frequently serve as means of rescue rather than as providers of emergency treatment.

Accidents↗
PubMed2005

Measurement of thirteen biological markers in CSF of patients with Alzheimer's disease and other dementias.

Cerebrospinal fluid (CSF) biological markers may be of valuable help in the diagnosis of dementia. The aim of the present study was to evaluate CSF levels of 13 potential biomarkers in patients with Alzheimer's disease (AD), frontotemporal lobe dementia, alcohol dementia, major depression and control patients without any neuropsychiatric disease. The study was performed using beta-amyloid 1-42 (Abeta42), total tau and phosphorylated tau-181 (P-tau181) as core markers. The ratio P-tau181/Abeta42 could significantly distinguish AD patients from all other diagnostic subgroups. CSF levels of 5 growth factors (HGF, GDNF, VEGF, BDNF, FGF-2) and 3 cytokines/chemokines (TNF-alpha, TGF-beta1, MIP-1alpha) did not significantly differentiate between the studied groups. However, depending on the degree of neurodegeneration (as expressed by the ratio P-tau181/Abeta42), patients with AD displayed significantly increased CSF levels of nerve growth factor (NGF) as compared to healthy controls. CSF levels of monocyte chemoattractant protein 1 (MCP-1) were found to be significantly increased with age in all groups but did not distinguish AD patients from healthy controls. The results confirmed the suitability of the ratio P-tau181/Abeta42 for the diagnosis of AD, while CSF levels of NGF and MCP-1 are less specific and reliable for AD. It is suggested that the increase in NGF depends on the extent of neurodegeneration of the AD type and the increase in MCP-1 on age.

Aged↗
PubMed2005

Morphologic changes of the uteroplacental unit in preeclampsia-like syndrome in rats.

OBJECTIVE: Chronic administration of the nitric oxide synthase inhibitor NG-nitro-L-arginine methylester (L-NAME) induces a preeclampsia-like syndrome in rats. This animal study aims to determine whether L-NAME-induced preeclampsia-like syndrome is also associated with morphologic changes in the uteroplacental unit. METHODS: Mating was induced in 20 adult Sprague-Dawley rats. On day 14, five pregnant rats were randomly assigned to receive L-NAME, whereas six served as controls. Weight, continuous blood pressure, urine volume, urine protein content, litter size, number of resorption sites, placental weight, and weight of pups were documented. Uteroplacental tissue of three L-NAME and three control animals were processed for microscopy using corrosion cast technique. RESULTS: The L-NAME-treated animals had a significantly smaller litter size (p=.033) and a significantly higher number of resorption sites (p=.021) when compared to controls. In L-NAME-treated rats midlength inner-diameter of maternal arterial channels (p<.001) and cross-sectional area (p<.001) were significantly smaller than were those in controls. CONCLUSIONS: Chronic administration of L-NAME to pregnant rats is associated with significant morphologic changes of the uteroplacental vasculature. The L-NAME-induced pathologic alterations resulted in decreased litter size and increased number of resorption sites that may be contributed to diminished uteroplacental perfusion.

Animals↗
PubMed2005

The potential of venous air embolism ascending retrograde to the brain.

A bench study was performed to investigate the potential of air bubbles entering a central vein via a central venous catheter to ascend retrograde to the brain. The results support the hypothesis that air bubbles may rise retrograde against the venous blood flow, depending on bubble size, central vein diameter and cardiac output. A review of radiological findings in published case reports indicates that the occurrence of retrograde cerebral air embolism is underestimated.

Animals↗
PubMed2004

Frequency of rib and sternum fractures associated with out-of-hospital cardiopulmonary resuscitation is underestimated by conventional chest X-ray.

OBJECTIVE: Fractured ribs and sternum are frequent complications of thoracic compression during CPR in adults. This study was conducted to determine whether findings of plain chest radiography (CXR) correlate with post-mortem findings in patients who underwent cardiopulmonary resuscitation (CPR) after out-of-hospital cardiac arrest. METHODS: CXR findings and autopsy results of CPR-related chest injuries comprising rib and sternum fractures were compared prospectively in 19 patients. RESULTS: Fractures were diagnosed in nine of 19 patients by means of radiology and in 18 of 19 patients by autopsy (rib fractures in 6/19 versus 17/19, P=0.002; sternum fractures in 5/19 versus in 9/19, P=0.227. The total number of isolated bone fractures detected by CXR was 18 (12 rib and six sternum fractures) and by autopsy 92 (83 rib and nine sternum fractures). The majority of rib fractures was located in the anterior part of the thoracic cage. Sternum fractures predominantly occurred in the lower third. Eight of 19 patients received either thrombolytic or antithrombotic treatment during CPR but no major bleeding complication associated with CPR was detected by autopsy. CONCLUSIONS: The findings of this study indicate that fractures associated with CPR are underreported in conventional radiographic investigations. No major bleeding complications related to CPR-associated fractures was detected.

Adult↗
PubMed2004

Long-term survival and neurological outcome of patients who received recombinant tissue plasminogen activator during out-of-hospital cardiac arrest.

OBJECTIVE: The long-term outcome in patients who received recombinant tissue plasminogen activator during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) of non-traumatic aetiology was assessed. METHODS: The neurological outcome in survivors and their level of performance, subjective well-being and quality of life were evaluated. RESULTS: A follow-up study of 27 cardiac arrest survivors was conducted; four patients (15%) died during the first year, a total of seven patients (26%) within 5 years. Twenty-two patients (81%) were discharged from hospital without neurological deficit (cerebral performance category (CPC) score: 1), three patients scored CPC 2 and two patients CPC 3. Heart failure classification on discharge was, according to the New York Heart Association (NYHA) criteria 2.1 +/- 0.9. Fifteen patients (56%) managed to return to their previous level of activity. At the time of follow-up 18 patients (67%) were still alive, of whom 15 responded to a survey regarding life satisfaction. Thirteen patients (87%) judged their situation to be worth living and twelve (80%) considered their survival a second chance, while five (33%) feared they could suffer another cardiac arrest. Reactions from close relatives included fear/anxiety (n = 14; 78%), a sustained burden on family life (n = 12; 67%), and occasional depression (n = 7; 39%). CONCLUSIONS: Thrombolytic therapy during cardiopulmonary resuscitation may produce a favourable neurological outcome. The majority of long-term survivors reported a good subjective quality of life. In one-third of close family members some negative factors had a lasting impact on the quality of daily living.

Adult↗
PubMed2003

Acute pain is underassessed in out-of-hospital emergencies.

OBJECTIVES: To evaluate the quality of pain assessment by emergency medical services (EMS) in out-of-hospital emergencies. METHODS: A prospective study was conducted on a convenience sample of patients during a one-year observation period. Pain ratings assessed by emergency patients were documented at three different intervals during the emergency call, and compared with concomitant assessments by EMS providers. A visual analog scale (VAS) and a verbal pain scale (VPS) were used for pain assessment. Repeated-measures ANOVA and Dunnett's t-test were used for data analysis. RESULTS: Fifty-one out of 70 eligible patients met inclusion criteria. In most emergency patients the intensity of pain was underestimated by EMS, especially when pain was severe (p = 0.0001). During the course of transport, both pain and pain assessment by EMS improved significantly (p = 0.0001). The VAS and VPS were significantly correlated (p = 0.0001). CONCLUSIONS: EMS providers significantly underestimate their patients' pain severity. EMS providers should be more attentive to their patients' complaints and comfort.

Acute Disease↗