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  • 1
    Electronic Resource
    Electronic Resource
    Minimum local analgesic dose of plain ropivacaine vs. ropivacaine combined with sufentanil during epidural analgesia for labour (2001)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 56 (2001), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We have used the up-and-down allocation technique to assess the relative analgesic potencies of epidural ropivacaine alone and ropivacaine combined with sufentanil 0.75 µg.ml−1 in 42 women requesting epidural analgesia in the first stage of labour. Parturients were randomly allocated to one of the two epidural solutions in a double-blind manner. The concentration of local anaesthetic was determined by the response of the previous parturient: an effective concentration (pain ≤ 10 mm on a 10-cm visual analogue pain score within 30 min) resulted in a 0.01% decrease in the concentration of ropivacaine for the next parturient, an ineffective concentration resulted in a 0.01% increase. Minimum local analgesic concentration of ropivacaine alone was 0.13% (95% CI 0.12–0.13%) compared with 0.09% (95% CI 0.08–0.1%) for ropivacaine with sufentanil (p 〈 0.00001).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2001.02050.x
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  • 2
    Electronic Resource
    Electronic Resource
    The pharmacokinetics of caudal ropivacaine 0.2% in children (2000)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 55 (2000), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study evaluates the pharmacokinetics of ropivacaine in children after caudal epidural injection. Twenty male children undergoing inguinal hernia repair were enrolled after ethics committee approval and informed parental consent, and were grouped according to age (10 ‘infants’ aged less than 1 year and 10 ‘toddlers’ aged 1–5 years). After induction of general anaesthesia, caudal epidural injection using ropivacaine 0.2% 1 ml.kg−1 was performed. Plasma concentrations of ropivacaine in the first 2 h after injection were determined by reversed-phase high-pressure liquid chromatography. Caudal blockade with ropivacaine 2 mg.ml−1 resulted in mean (SD) peak plasma concentrations of 0.73 [0.27]µg.ml−1 in infants and 0.49 [0.21]µg.ml−1 in toddlers (p 〈 0.01). Maximum plasma concentrations occurred after a median [range] period of 60 [15–90] min and 52.5 [30–120] min in infants and toddlers, respectively. Two infants (weighing 3.8 and 5.0 kg) showed the highest individual maximum plasma concentrations: 1.31 and 1.11 µg.ml−1. No clinical signs of local anaesthetic toxicity were observed. The results of the present investigation suggest that, from a pharmacokinetic point of view, caudal blockade using ropivacaine 0.2% 1 ml.kg−1 can be regarded as a safe technique in children, i.e. in infants as well as in toddlers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2000.01537.x
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  • 3
    Electronic Resource
    Electronic Resource
    Impact of a multimodal anti-emetic prophylaxis on patient satisfaction in high-risk patients for postoperative nausea and vomiting (2002)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Postoperative nausea and vomiting (PONV) are frequent and unpleasant symptoms. This prospective study aimed to assess the efficacy of a multimodal approach to prevent PONV, and patient satisfaction using the willingness-to-pay method. Two validated risk scores were applied to forecast the individual risk for PONV in 900 consecutive patients of whom 108 were identified as high-risk patients (predicted risk: 79–87%). High-risk patients received multimodal anti-emetic prophylaxis: total intravenous anaesthesia with propofol, high fractional inspired oxygen (80%), omission of nitrous oxide, dexamethasone 8 mg, haloperidol 10 µg.kg−1, and tropisetron 2 mg. Of the remaining patients with low or moderate risk for PONV, a random sample of 71 females received balanced propofol-desflurane anaesthesia without prophylactic anti-emetics. All patients were interviewed 2 and 24 h after surgery for occurrence of nausea and vomiting. Patient satisfaction was measured using the willingness-to-pay method. The incidence of PONV (95%-confidence interval) in the control-group was 41% (29–51%), slightly lower than predicted by the risk scores (53–57%). The multimodal anti-emetic approach reduced the predicted risk (79–87%) in the high risk-group to 7% (3–14%). This was associated with a high willingness-to-pay median (25th/75th percentile) of £84 (£33–184) in the multimodal anti-emetic grouped compared to £14 (£4–30) in the control group. A multimodal anti-emetic approach can considerably reduce the incidence of PONV in high-risk patients and is associated with a high patient satisfaction as measured by the willingness-to-pay method.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2002.02822.x
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  • 4
    Electronic Resource
    Electronic Resource
    The molecular determinants of sunburn cell formation (2001)
    Copenhagen : Munksgaard International Publishers
    Experimental dermatology 10 (2001), S. 0 
    Details
    ISSN: 1600-0625
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Sunburn cell (SBC) formation in the epidermis is a characteristic consequence of ultraviolet radiation (UVR) exposure at doses around or above the minimum erythema dose. SBC have been identified morphologically and biologically as keratinocytes undergoing apoptosis. There is evidence that SBC formation is a protective mechanism to eliminate cells at risk of malignant transformation. The level of DNA photodamage is a major determinant of SBC induction by a process controlled by the tumor suppressor gene p53. However, extra-nuclear events also contribute to SBC formation, such as the activation of death receptors including CD95/Fas. UVR triggers death receptors either by direct activation of these surface molecules or by inducing the release of their ligands such as CD95 ligand or tumor necrosis factor. Oxidative stress also appears to be involved, probably via mitochondrial pathways, resulting in the release of cytochrome C. Pathways which modify SBC formation are now extensively studied given the importance of apoptosis in eliminating irreparably damaged cells. A greater understanding of the mechanisms that induce and prevent UVR-induced apoptosis will contribute to our understanding of mechanisms relevant in genomic integrity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1034/j.1600-0625.2001.010003155.x
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  • 5
    Electronic Resource
    Electronic Resource
    On the Role of Calcium Ions in the Regulation of Glycogenolysis in Mouse Brain Cortical Slices (1982)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of neurochemistry 38 (1982), S. 0 
    Details
    ISSN: 1471-4159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: Using mouse brain cortical slices, we investigated the relative roles of cyclic AMP and of calcium ions as the intracellular messengers for the activation of glycogen phosphorylase (EC 2.4.1.1; α-1,4-glucan:orthophosphate glucosyltransferase) induced by noradrenaline and by depolarization. Activation of phosphorylase by 100 μM noradrenaline is mediated by β-adrenergic receptors and does not require the copresence of adenosine. The role of the concomitant small increase in cyclic AMP is questioned. Short-term treatment with EGTA or LaCl3 abolishes the noradrenaline activation of phosphorylase, pointing to a critical role of extracellular calcium. Depolarization by 25 mM K+ or 100 μM veratridine produces a rapid and large (fourfold) activation of phosphorylase. Only veratridine increases the cyclic AMP levels; exogenous adenosine deaminase essentially blocks this cyclic AMP accumulation but not the phosphorylase activation. A halfmaximal activation of phosphorylase occurs at about 12 mM K+. Addition of EGTA or LaCl3, reduces the effect of both depolarizations to a slight and transient activation of phosphorylase. These results indicate that activation of glycogen phosphorylase by K+ or veratridine occurs by a cyclic AMP-independent and calcium-dependent mechanism. The calcium dependency of brain phosphorylase kinase renders this kinase the prime target enzyme for regulation of glycogenolysis by calcium ions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-4159.1982.tb07903.x
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  • 6
    Electronic Resource
    Electronic Resource
    Ein neuartiges Bauprinzip in den Kristallstrukturen der Bleiniobate vom Pyrochlor-Typ (1980)
    Springer
    Naturwissenschaften 67 (1980), S. 141-142 
    Details
    ISSN: 1432-1904
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Chemistry and Pharmacology , Natural Sciences in General
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01073617
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  • 7
    Electronic Resource
    Electronic Resource
    Stellvertreterentscheidungen in Gesundheitsfragen und Vorausverfügungen von Patienten Eine praxisorientierte Übersicht zu rechtlichen und ethischen Problemen bei der Behandlung nicht einwilligungsfähiger Personen (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 657-674 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Behandlungseinwilligung ; Stellvertreterentscheidungen in Gesundheitsfragen ; Betreuungsrecht ; Epidemiologisch-pragmatische Probleme ; Patientenverfügungen ; Ethik in der Medizin ; Key words Informed consent ; Surrogate decision-making in health care ; Durable power of attorney ; Epidemiologic and pragmatic problems ; ;Advance directives ; Medical ethics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Except in emergencies, the medical treatment of incompetent patients also has to be based upon an informed consent between the physician and a legitimated legal representative (durable power of attorney). Consequently, the German ‘Betreuungsrecht’ advices persons to designate in advance such a proxy or surrogate. However, an additional court-decision is demanded, if a medical measure poses significant risks for the future health or the life of the incompetent patient. On the base of the available epidemiologic data we illustrate that neither our medical nor our legal system could realistically cope with the practical consequences of this legislation: The vast majority of our present decisions in such cases is not covered by a legally valid informed consent, which implies possible forensic consequences. This article provides relevant clinical and legal advice on how to protect the legitimate interests of all concerned within the present framework, which should urgently be revised.
    Notes: Zusammenfassung Elektive Heileingriffe bei nicht-einwilligungsfähigen Patienten bedürfen einer rechtswirksamen Einwilligung, die im Allgemeinen bei einem hierzu ausdrücklich legitimierten Stellvertreter einzuholen ist. Daher empfiehlt auch das deutsche Betreuungsrecht, durch eine Vorausverfügung einen Betreuer oder Vorsorgebevollmächtigten für den Fall der eigenen Einwilligungsunfähigkeit zu benennen. Zusätzlich wird jedoch auch eine vormundschaftsgerichtliche Genehmigung gefordert, wenn “die begründete Gefahr besteht, dass der Betreute aufgrund der Maßnahme stirbt oder einen schweren und länger dauernden gesundheitlichen Schaden erleidet”. Auf Grundlage der verfügbaren epidemiologischen Daten belegen wir, dass diese gesetzliche Vorgabe weder im Bereich der Justizverwaltungen und Gerichte noch der Medizin praktisch realisierbar ist: Die große Mehrheit entsprechender Therapieentscheidungen ist daher in Deutschland derzeit nicht durch rechtswirksame Einwilligungen gedeckt – mit potentiell weitreichenden forensischen Konsequenzen. Dieser Artikel gibt klinische und juristische Hinweise, wie die legitimen Interessen aller Beteiligten derzeit am ehesten gewahrt werden können. Die momentane Rechtslage sollte dringend reformiert werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070083
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  • 8
    Electronic Resource
    Electronic Resource
    Ist die Inzidenz postoperativen Erbrechens abhängig vom operativen Eingriff? Erwiderung auf einen Leserbrief in Der Anaesthesist (2000) 49:227–229 (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 911-912 
    Details
    ISSN: 1432-055X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070048
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  • 9
    Electronic Resource
    Electronic Resource
    Chromosome analysis in patients with sarcoidosis (1980)
    Springer
    Archives of dermatological research 268 (1980), S. 9-13 
    Details
    ISSN: 1432-069X
    Keywords: Chromosome-breaks ; Chromosome-gaps ; Chromosomes ; Glucocorticoide ; Hypomodal cells ; Sarcoidosis ; Chromosomenspalt ; Chromosomenbruch ; Chromosomen ; Glucocorticoide ; hypomodale Zellen ; Scaroidosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Chromosom-Analyse der Lymphocyten des peripheren Blutes von 20 Patienten mit Sarcoidosis und 10 gesunden Kontrollpersonen zeigte eine signifikant größere Anzahl von hypomodalen Zellen bei den Patienten. Zwei Patienten, die mit Glucocorticoiden behandelt wurden, hatten viele chromosomale Mißbildungen.
    Notes: Summary Chromosome analysis of lymphocytes from the peripheral blood of 20 patients with sarcoidosis and 10 healthy controls showed a significantly greater number of hypomodal cells among the patients. Two patients receiving systemic treatment with glucocorticoids had many chromosomal aberrations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00403881
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  • 10
    Electronic Resource
    Electronic Resource
    Localization of radioactivity in rat organs after oral administration of tritiated 8-methoxypsoralen in therapeutic doses (1982)
    Springer
    Archives of dermatological research 273 (1982), S. 71-84 
    Details
    ISSN: 1432-069X
    Keywords: 3H-8-MOP ; DNA-RNA protein activity ; 3H-8-MOP time activity curves ; Rat organs
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Tritiated 8-methoxypsoralen was given perorally to rats in amounts corresponding to therapeutic human doses. The rats were exposed to UVA light or kept in darkness. None of the fractions (apart from 3H2O from the lens) examined changed their level of radioactivity under the influence of UVA light. Time-radioactivity curves were recorded for the skin, lens, residual eye, and the liver. Four fractions were measured: 3H2O, soluble pool, DNA-RNA, and protein. Tritiated water appeared already 1 h after ingestion, and attained maximum value 9–24 h after ingestion, indicating the efficiency with which the liver degrades 8-MOP. 3H-8-MOP and metabolites could be detected in the soluble pool in maximum amounts 2–3 h after the administration. Pretreatment with trypsin increased the concentration of 3H-8-MOP and metabolites; the origin of this extra radioactivity was the protein fraction. The 3H-8-MOP binding to DNA or RNA was studied by pretreatments of the homogenates with DNase or RNase followed by measurement of radioactivity in the TCA extracts. This indicated that no measurable amount of 3H-8-MOP had been bound to DNA or RNA. We conclude that 8-MOP administered to rats in amounts corresponding to human therapeutic doses does not bind to DNA or RNA in measurable amounts either after UV-light or in darkness. The experiments have shown proteins to be the main binding site in rat organs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00509029
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