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  • 1
    ISSN: 1432-1106
    Keywords: Human movement ; Spastic hemiparesis ; Bimanual coordination
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A Fitts' task was used to examine whether the large movement asymmetry in subjects with spastic hemiparesis can be reduced or eliminated when both limbs are required to perform functionally equivalent tasks. Furthermore, it was determined whether any such benefit was expressed as mutual accommodation, or whether one hand “slaves” the other. Finally, the effect of increased task constraints on the magnitude of the asymmetry was considered. A group of ten students served as controls. Subjects had to grasp small balls and subsequently place them into holes. As expected, large total response time differences were present between the hands of the hemiparetic subjects in the unimanual conditions. However, 92% of the difference between hands was eliminated in the bimanual conditions. It is argued that the observed temporal invariance, or time locking, between hands in the bimanual conditions might be facilitated through the activity of bilateral controls exerted from each hemisphere and neural crosstalk at different levels of the central nervous system. Still, an asymmetric tendency remained in the bimanual conditions: a tendency existed for the impaired hand to reach the “target” later in time compared with the dominant hand. This tendency was enlarged as the asymmetry in task demands for the two limbs increased.
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  • 2
    ISSN: 1432-1238
    Keywords: Low T3 syndrome ; Selenium ; Deiodination ; Glutathione peroxidase ; Balance study ; Critically ill ; Trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective Thyroxine (T4) is deiodinated to triiodothyronine (T3) by the hepatic type I iodothyronine deiodinase, a selenoprotein that is sensitive to selenium (Se) deficiency. After severe injury, T4 deiodination is decreased, leading to the low T3 syndrome. Injury increases free radical production, which inactivates the iodothyronine deiodinase. The aims were to study the Se status after major trauma and to investigate its relation to the low T3 syndrome. Design Preliminary prospective descriptive study. Setting Intensive care unit at a university teaching hospital. Patients and methods 11 patients aged 41±4 years (mean±SEM), with severe multiple injuries (Injury Severity Score 29±2 points). A balance study was performed from day 1 to day 7. Serum and urine samples were collected from the time of admission until day 7, then on days 10, 15, 20, 25 and 30. Nonparametric tests and Pearson's correlation coefficients were used for analysis. Results Cumulated Se losses were 0.88±0.1 μmol/24h. Serum Se was decreased from admission to day 7. T3, free T3, and the T3/T4 ratio were low until day 5, being lowest on day 2; T4 and thyroid stimulating hormone were normal. Serum Se was correlated with T3 (r=0.55,p=0.0001), and with free T3 (r=0.35). Conclusion Se status is altered after trauma, with decreased Se serum levels upon admission to the ICU but with no major Se losses. Se is probably redistributed to the tissues. The correlation between Se and T3, along with the parallel decrease in T4 deiodination, indicates that reduced deiodination might be related to the transient decrease in serum Se.
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  • 3
    ISSN: 1432-1130
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract  The effect of silicon and titanium on the spallation resistance of alumina scales formed on NiCrAlY-type alloys has been investigated using model alloys with different additions of Si or Ti. For this purpose cyclic oxidation experiments were carried out at temperatures between 950 and 1100 °C. For evaluation of the growth and temperature induced stresses in the oxide scales selected samples were analysed by X-ray stress evaluation (XSE) at ambient temperature after various oxidation treatments. The compressive strains in the scales were found to increase with increasing oxidation time, tending to become constant after longer oxidation times. The strains reduced remarkably, when scale damage, such as cracking, started. The developed strains in the oxide scales appeared to be affected by the microstructure of the alloy and the phase distribution in the subsurface depletion layer beneath the oxide. This distribution is affected by the presence of Si and Ti. Apart from the X-ray method, laser Raman spectroscopy (LRS) was calibrated for strain measurement by XSE results aiming at applying this method for stress analysis at higher temperatures.
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  • 4
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Atopisches Ekzem ; Nahrungsmittelallergie ; Psychosomatik ; Mutter-Kind-Beziehung ; Key words Atopic eczema ; Food allergy ; Psychosomatics ; Mother-child relationship
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Atopic eczema is one of the most frequent dermatological diseases, with a still increasing incidence. Although its etiopathogenesis is still not completely understood, a variety of triggering factors are known. The following case report describes the clinical course of atopic dermatitis in a 2-year-old boy in whom both IgE-mediated allergic reactions and psychological factors were involved in triggering and maintenance of skin lesions. This demonstrates how important both dermatological therapy and close cooperation with the field of psychosomatic medicine can be.
    Notes: Zusammenfassung Das atopische Ekzem zählt zu den häufigsten dermatologischen Erkrankungen mit zunehmender Inzidenz. Obwohl die Ätiopathogenese letztendlich ungeklärt ist, sind eine Vielzahl auslösender Faktoren bekannt. Anhand der Falldarstellung eines 2jährigen Kindes, bei dem sowohl IgE-vermittelte allergische Reaktionen als auch psychische Faktoren an der Auslösung und Unterhaltung der Hautveränderungen beteiligt waren, soll aufgezeigt werden, daß eine erfolgreiche Behandlung des atopischen Ekzems in vielen Fällen neben dermatologisch-allergologischen Therapieansätzen ebenso eine enge Kooperation mit dem Fachgebiet der Psychosomatik erforderlich macht.
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  • 5
    ISSN: 1432-1076
    Keywords: Infant ; Fever ; Bacterial infection ; Logistic regression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Low risk criteria have been defined to identify febrile infants unlikely to have serious bacterial infection (SBI). Using these criteria approximately 40% of all febrile infants can be defined as being at low risk. Of the remaining infants (60%) only 10%–20% have an SBI. No adequate criteria exist to identify these infants. All infants aged 2 weeks-1 year, presenting during a 1-year-period with rectal temperature ≥38.0°C to the Sophia Children's Hospital were included in a prospective study. Infants with a history of prematurity, perinatal complications, known underlying disease, antibiotic treatment or vaccination during the preceding 48 h were excluded. Clinical and laboratory variables at presentation were evaluated by a multivariate logistic regression model using SBI as the dependent variable. By using likelihood ratios a predictive model was derived, providing a post test probability of SBI for every individual patient. Of the 138 infants included in the study, 33 (24%) had SBI. Logistic regression analysis defined C-reactive protein (CRP), duration of fever, a standardized clinical impression score, a history of diarrhoea and focal signs of infection as independent predictors of SBI. Conclusion CRP, duration of fever, the “standardized clinical impression score”, a history of diarrhoea and focal signs of infection were the independent, most powerful predictors of SBI in febrile infants, identified by logistic regression analysis. Although the predictive model is not validated for direct clinical use, it illustrates the clinical potential of the used technique. This technique offers the advantage to assess the probability of SBI in every individual infant. This probability will form the best basis for well-founded decisions in the management of the individual febrile infant.
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  • 6
    ISSN: 1432-1106
    Keywords: Prehension ; Motor control ; Altered hand position ; Human
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Past studies have examined the coupling of reach and grasp components during prehensile movements. Many of these studies have supported the view that these components reflect the output of two parallel, though temporally coupled, motor programs. When the grip aperture is Altered prior to the onset of prehension from its usual, normally flexed position to one of maximal finger extension, our previous work has shown that the grasp component appears to reorganize itself during the reach. This reorganization, consisting of a brief closing and reopening of the grip aperture, only slightly influenced the temporal components of the wrist transport. The present experiment continues this research theme by examining the characteristics of grip aperture reorganization through the comparison of the kinematics of prehension components during movements to two different size objects under normal and Altered grip aperture conditions. It was hypothesized that if the grip reorganization is task dependent it should be related to object size. The experiment found that in the Altered grip condition reorganization did occur, as indicated by a slight closing and reopening of the aperture without influencing the transport of the wrist. The amplitude of and the time to the observed inflection point in the aperture time course were related to object size. The velocity of grip closing for the large object showed double peaks, with the first substantially smaller than the second. Moreover, for the small object, the velocity of grip aperture closing also was double peaked, but the difference between peaks was less pronounced. These changes in grip velocity suggest that the grip reorganization is related to object size. No effect of Altered aperture was observed on the transport component. For both object sizes in the Altered condition, the final peak velocity of grip aperture was statistically significantly correlated with transport time and time to peak deceleration. In contrast, such correlations were not observed for the initial peak velocity of the grip aperture. Furthermore, time to maximum grip aperture was correlated with both time to peak wrist velocity and time peak to wrist deceleration. Thus, as the reach progressed toward the object, the grip and transport components became more interdependent. The results are consistent with the notion that, when a well-practiced, coordinated act such as prehension is confronted with an Altered grip posture at the onset of the reach, the grip can be reorganized during the transport to preserve the relative timing between them. Thus these data add to the growing awareness that not only is there temporal coupling between the reach and grasp components but that these components may be integrated by higher-order control mechanism.
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  • 7
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Chronisches Müdigkeitssyndrom ; Depression ; Kognitive Verhaltenstherapie ; Übersichtsarbeit ; Key words Chronic fatigue syndrome ; Depression ; Cognitive behavioral therapy ; Review
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary This article reviews the chronic fatigue syndrome (CFS), a disorder whose etiology is unknown. The diagnostic criteria proposed in 1994 by the CDC and the International Chronic Fatigue Syndrome Study Group are introduced. In contrast to widespread belief, there are no laboratory tests available to underpin the diagnosis of CFS; the diagnosis is made solely on the basis of clinical criteria. In the differential diagnosis, the exclusion of other conditions that can cause chronic fatigue, such as neuropsychiatric or sleep disorders, is of critical importance. In this context, the question as to whether CFS is a clinical entity that can be differentiated from psychiatric diagnoses, such as depression, somatoform disorder, or neurasthenia, is discussed. At the moment, there is no specific therapy for CFS. Therefore, therapeutic approaches are limited to symptomatic management of the concomitant sleep disturbances, pain, or psychiatric symptoms, such as depression. Patients may benefit from cognitive behavioral therapy, as this may help then to identify and exclude factors contributing to and maintaining chronic fatigue. An integrated medical and psychological approach should be adopted, with the aim of preventing significant secondary negative results of the illness, such as interpersonal conflicts or chronic disability.
    Notes: Zusammenfassung Das „Chronische Müdigkeitssyndrom“ (CFS) ist eine Erkrankung, deren Pathogenese bis heute nicht geklärt ist. Diese Übersichtsarbeit stellt die neuesten diagnostischen Kriterien vor, die 1994 von den „Centers of Disease Control“ und der „International Chronic Fatigue Syndrome Study Group“ erarbeitet wurden. Im Gegensatz zu einer weitverbreiteten Meinung gibt es keine objektivierbaren Parameter, die die Diagnose eines CFS stützen oder sichern könnten. Die Diagnose wird nach rein klinisch-deskriptiven Kriterien gestellt. Dem Ausschluß anderer Erkrankungen, die zu chronischer Müdigkeit führen können, kommt im Rahmen der Diagnostik eine zentrale Bedeutung zu, wobei die Differentialdiagnose zu neuropsychiatrischen Erkrankungen einschließlich Schlafstörungen am wichtigsten ist. In diesem Zusammenhang wird diskutiert, ob das CFS eine Krankheitsentität darstellt oder in psychiatrischen Diagnosen, wie z. B. Depression, somatoformen Störungen oder Neurasthenie, aufgeht. Eine spezifische Therapie des CFS steht bisher nicht zur Verfügung. Medikamentöse Maßnahmen beschränken sich daher auf eine symptomatische Therapie z. B. von Schlafstörungen, Schmerzen und psychischen Begleitsymptomen. An einem CFS leidende Patienten können auch von einem verhaltensmedizinisch orientierten Vorgehen profitieren, das Faktoren aufdeckt und bearbeitet, welche die Symptomatik des CFS verschlimmern oder aufrechterhalten. Ziel aller therapeutischen Bemühungen ist es dabei, negativen Folgen der chronischen Erkrankung, wie z. B. interpersonellen Konflikten, sozialem Rückzug oder Arbeitslosigkeit, vorzubeugen.
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  • 8
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Cytochrom P450 ; Pharmakokinetik ; Selek- tive Serotonin-Wiederaufnahmehemmer ; Genetischer Polymorphismus ; Interaktionen ; Key words Cytochrome P450 ; Pharmacokinetics ; Selective serotonin reuptake inhibitors ; Gemetic polymorphism ; Drug interactions
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Nearly all psychotropic drugs are metabolized by hepatic cytochrome P450-enzymes. In humans, there are 5 isoenzymes involved in this process. The activity of these enzymes can be modulated by a number of commonly used drugs, yielding potentially hazardous interactions. Most of the recently introduced selective serotonin reuptake inhibitors are potent inhibitors of cytochrome P450 enzymes. Thus, the plasma concentrations of tricyclic antidepressants or clozapine might be elevated into toxic levels. In contrast, carbamazepine induces most of the isoenzymes. This potentiates the elimination of tricyclics and antipsychotics and might cause a serious risk for the reccurence of depressive or psychotic symptoms. Moreover, 5–10% of the population are slow metabolizers of CYP2D6. This group is prone to increased adverse effects of moderately dosed medication. This review systematically points out the reported or predicted pharmacokinetic drug interactions in psychopharmacology focussing on clinical significance.
    Notes: Zusammenfassung Fast alle Psychopharmaka werden durch die Cytochrom-P450-Enzyme der Leber abgebaut. Beim Menschen sind mindestens 5 Isoenzyme für diesen Prozeß verantwortlich. Diese können in jeweils unterschiedlichem Umfang durch eine Reihe von Medikamenten in ihrer Aktivität beeinflußt werden. Bei gleichzeitiger Anwendung mehrerer Substanzen kann es durch diesen Mechanismus zu Wechselwirkungen mit potentiell ernsten Folgen kommen. So inhibieren die meisten der selektiven Serotonin-Wiederaufnahmehemmer P450-Enzyme und können dadurch z.B. die Plasmakonzentrationen von trizyklischen Antidepressiva in toxische Bereiche heben. Carbamazepin hingegen induziert viele der Isoenzyme; durch den schnelleren Abbau von Trizyklika oder Neuroleptika können zu geringe Konzentrationen dieser Substanzen resultieren und Rezidive von Depressionen oder Psychosen ausgelöst werden. Überdies weisen aufgrund eines genetischen Polymorphismus 5–10% der Bevölkerung eine geringere Aktivität des Isoenzyms CYP2D6 auf und reagieren deshalb mit verstärkten Nebenwirkungen auf übliche Dosierungen vieler Pharmaka. In dieser Übersichtsarbeit wird systematisch auf pharmakokinetische Interaktionen im Bereich der Psychopharmakologie hingewiesen, die bisher berichtet wurden oder zu befürchten sind. Besonderer Wert wird dabei auf die klinische Signifikanz solcher Ergebnisse gelegt.
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  • 9
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Aciclovir ; Zentralnervöse Nebenwirkungen ; Psychosyndrom ; Key words Acyclovir ; Adverse effects ; Psychosyndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary In differential diagnosis of a delir also adverse effects of medicaments have to be taken into account beside other causes. We report a case of an agitated delir with nocturnal disturbance of consciousness, confusion, restlessness and sleeplessness. This delir existed exclusively during the therapy of a cutaneous herpes zoster with zovirax®-pills which can only be explained by a causal connection – after exclusion of other causes. As a so far undescribed predisposition for neurotoxicity of oral therapy with acyclovir signs of vascular encephalopathy were found in the patient’s cranial magnetic resonance imaging. The central nervous side effects of acyclovir were summarized shortly.
    Notes: Zusammenfassung Bei der Differentialdiagnose eines Delirs müssen u. a. auch Medikamentennebenwirkungen bedacht werden. Vorgestellt wird ein Patient mit einem agitierten Delir in Form von nächtlicher Bewußtseinstrübung, Verwirrtheit, psychomotorischer Unruhe und Schlaflosigkeit. Dieses Delir bestand ausschließlich während der Therapie eines kutanen Herpes zoster mit Zovirax®-Tabletten, was – nach Ausschluß anderer Ursachen – nur durch einen kausalen Zusammenhang erklärt werden kann. Als eine bislang unbeschriebene Prädisposition für Neurotoxizität bei einer oralen Aciclovir-Therapie fanden sich im Kernspintomogramm des Patienten Zeichen einer vaskulären Enzephalopathie. Die zentralnervösen Nebenwirkungen von Aciclovir werden kurz zusammengefaßt.
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  • 10
    ISSN: 1433-0350
    Keywords: Key words Cerebellar astrocytoma ; Extent of tumor resection ; Pediatric brain tumor ; Volumetric analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Pediatric cerebellar astrocytomas are frequently curable by complete surgical resection. However, even incompletely resected tumors may lie dormant indefinitely or spontaneously involute, and tumors thought to be completely excised have reappeared in the same location several years later. Because of the unpredictable nature of some cerebellar astrocytomas, this study was designed to analyze several variables for their potential value in predicting disease progression. The charts of 78 children treated at a children's hospital between 1966 and 1993 were reviewed; 62 tumors were pilocytic, 13 were fibrillary, and 3 were mixed oligoastrocytomas. Four children had the additional diagnosis of neurofibromatosis type 1, and those children were considered separately. Of the remaining 74 children, 48 underwent postoperative contrast-enhanced computerized tomography or magnetic resonance imaging. Of those 48 children, 17 had residual disease, and in 15 cases the tumor volume could be measured. Frequently the surgeon's report conflicted with the postoperative scan regarding the presence of residual disease. However, the surgeon's report of brainstem infiltration correlated highly with residual disease on postoperative imaging. On univariate Cox analysis, sex, age, tumor location, and tumor morphology did not show prognostic significance. In spite of their differences, the surgeon's report of residual tumor and the presence of residual disease on postoperative imaging were similar in their correlation with disease progression. However, on multivariate analysis, the volume of residual tumor was most closely linked with disease progression. Only the presence of fibrillary histology significantly complemented the volume of residual tumor as a negative prognostic indicator.
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