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  • 11
    ISSN: 1432-2218
    Keywords: Key words: Familial adenomatous polyposis — Endoscopy — Surveillance — Gastroduodenal polyps and carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Malignant degeneration of gastroduodenal polyps has been noted in patients with familial adenomatous polyposis. To evaluate this problem further, patients with familial adenomatous polyposis were contacted and offered upper gastrointestinal tract endoscopy. Methods: A prospective endoscopic examination was performed in 42 patients. Results: The median age of patients at endoscopy was 35 years. The duration of known familial adenomatous polyposis at the time of endoscopy was 8 years. Polyps were visualized in 21 patients (50%). Gastric polyps were seen in 14 patients (33%), duodenal polyps were seen in 11 patients (26%), and ampullary polyps were seen in 7 patients (17%). Nine patients (43%) had polyps in more than one site. Adenomatous change was noted in 73% of duodenal lesions and in only 14% of gastric polyps. Surgical intervention was required in four patients; one patient had an early ampullary carcinoma, and three patients had severe dysplasia involving the duodenum or ampulla. All four patients had undergone a previous screening examination, results of which were normal in three patients. Compared with other patients, these four patients were older (median age, 58 years; p= 0.02) and had a longer duration of disease (median duration, 25 years; p= 0.002). Conclusions: All patients with familial adenomatous polyposis require lifelong endoscopic surveillance to detect malignant degeneration, which may appear later in life.
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  • 12
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Scoop and run ; Stay and play ; Einsatzstrategie ; Vitalfunktionen ; Notarztsystem ; Key words Scoop and run ; Stay and play ; Emergency strategies ; Vital functions ; EMS ; system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract „Stay and play,” especially in emergency patients with unstable vital functions, offers definite advantages compared to ”scoop and run” policies. Typical medical and tactical aspects can be identified to judge the amount of diagnostic and therapeutic measures necessary at the site and during transport. Scoop and run seems to be appropriate only rarely in a area with an emergency medical system in the German style.
    Notes: Zusammenfassung Die Erstversorgung von Notfallpatienten, insbesondere bei instabilen Vitalfunktionen, sollte grundsätzlich Vorrang vor dem hektischen Beginn eines Transports ohne vorherige Einleitung sichernder Maßnahmen haben. Dabei lassen sich typische medizinische und einsatztaktische Aspekte herausstellen, die Hinweise für den vor Ort und auf dem Transport erforderlichen Umfang von diagnostischen und therapeutischen Maßnahmen und ein differenziertes Vorgehen in Verlauf liefern. Nur in Ausnahmesituationen erscheint in einem voll ausgebauten notfallmedizinischen System deutscher Prägung eine scoop and run-Strategie angemessen.
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  • 13
    ISSN: 1432-055X
    Keywords: Schlüsselwörter: Kardiopulmonale Reanimation: Defibrillation – Halbautomatische Defibrillatoren –Überlebensrate – Neurologische Langzeitprognose – Rettungssystem: Behandlungsqualität – Logistische Strukturen ; Key words: Cardiopulmonary resuscitation: defibrillation – Semi-automatic defibrillators – Survival – Neurology – Emergency medical services systems: quality – Logistic structures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract. In a controlled prospective randomized study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany (basic life support by EMTs and defibrillation by emergency physicians only) in order to answer the following questions: 1. Does EMT defibrillation improve the survival rate and long-term prognosis of patients in ventricular fibrillation as compared to the current German standards in resuscitation (basic life support by EMTs and defibrillation by emergency physicians)? 2. Are the prerequisites for the use of semiautomatic defibrillators fulfilled in the emergency medical systems (EMS) of the participating centers? Methods. The study phase includes randomization of 121 adult patients with witnessed cardiac arrest and ventricular fibrillation (VF) as first ECG rhythm. Prior to the onset of the study, all EMTs of the participating EMS systems were retrained in basic life support (BLS) measures. In each center, randomly assessed EMT-Ds (EMTs trained in Defibrillation) were trained to use semiautomatic defibrillators. With the help of one-line tape recording, the time intervals during resuscitation and treatment steps were evaluated. Successfully resuscitated patients were followed up with the help of the Glascow Coma Scale and the Pittsburgh Cerebral and Overall Performance Categories. Results. From 1 February 1991 until 28 June 1992, 159 patients with VF were randomized. In 121 cases, collapse was witnessed. 25% (14/57) of the patients receiving defibrillation by EMT-Ds (study group=S) were discharged from the hospital alive. In the control group, 52 patients were defibrillated by emergency physicians, following BLS by EMTs [control group 1=C1; discharged: 29% (15/52)]. Fifty patients received BLS and advanced cardiac life support (ACLS) by the emergency physicians crews [control group 2=C2; discharged 18% (9/50)]. In the study group, the median time interval from collapse of the patient until initiation of BLS measures was 7.7 min, 7 min in C1 and 8 min in C2. ACLS measures were initiated significantly earlier (P〈0.05) in the control groups, as compared to the study group [S: 13 min, C1: 11 min; C2: 10.3 min]. Sixty-seven percent (30/45) of the study patients and 46% (36/76) of the control patients were defibrillated within 12 min. Study patients were defibrillated earlier (P〈0.05) (S: 9.9 min; C1: 12.2 min; C2: 12.75 min); return of spontaneous circulation (ROSC) was achieved earlier (P〈0.05) in the study group [S: 14 min; C1: 19 min; C2: 18.2 min] and the number of patients in the study group requiring no epinephrine during resuscitation was higher (P〈0.01) than in the control groups [S: 35.3% (12/34); C1: 10% (4/40); C2: 10.5% (4/38)]. Furthermore, the total amount of epinephrine [mean (±standard error)] administered in the study group [S: 2.35 (±0.49) mg; C1: 6.71 (±0.98) mg; C2: 7.71 (±1.31) mg] was significantly lower (P〈0.05). No significant differences in neurological long-term prognosis were found for the groups investigated. Conclusion. Neither the initial survival rate the number of patients discharged alive, nor the neurological long-term prognosis was significantly different for any of the groups investigated. Because of apparent differences in indirect prognostic parameters (time interval until ROSC, number of patients requiring no epinephrine) and because of the fact that the time interval to the first defibrillation was reduced by EMT defibrillation, EMT-Ds may perform defibrillation if: (a) they reach the patient before the emergency physician and (b) if they are trained intensively and supervised continuously. In order to increase the efficiency of defibrillation by EMT-Ds, far-reaching changes in our EMS are mandatory: (a) a reduction in the time interval from collapse until initiation of BCLS measures by intensifying layperson CPR training; (b) an increase in the number of emergency units equipped with semiautomatic defibrillators; (c) the consistent implementation of a tiered EMS.
    Notes: Zusammenfassung. In einer prospektiven Multicenterstudie wurde der Einfluß der Defibrillation durch Rettungsassistenten im Vergleich zum bisher praktizierten Verfahren (Basismaßnahmen der kardiopulmonalen Reanimation durch Rettungsassistenten und Defibrillation ausschließlich durch den Notarzt) auf die Überlebensrate und die neurologische Langzeitprognose bei 159 Patienten mit außerklinisch aufgetretenem Kammerflimmern untersucht. Alle Zeitintervalle des Reanimationsablaufs und die Behandlungsqualität wurden mittels Diktaphon erfaßt und nachvollzogen. Es bestanden keine signifikanten Unterschiede in der primären Überlebensrate, der Entlassungsrate und der neurologischen Langzeitprognose zwischen den untersuchten Gruppen. Aufgrund deutlicher Unterschiede zugunsten der Studiengruppe (Defibrillation durch Rettungsassistenten) in indirekten Parametern (kürzerer Zeitraum bis zur Wiederherstellung spontaner Kreislaufverhältnisse und größere Anzahl an Patienten, die kein Adrenalin benötigten) und der Tatsache, daß in den untersuchten Zentren der Zeitpunkt bis zur ersten Defibrillation signifikant nach vorne verlagert werden konnte, empfehlen wir die Defibrillation durch Rettungsassistenten: a) wenn sie den Patienten vor dem Notarzt erreichen, b) nach straffem Ausbildungsprogramm und unter kontinuierlicher ärztlicher Kontrolle. Um die Defibrillationsmaßnahme durch Rettungsassistenten effektiver werden zu lassen, müssen tiefgreifende Veränderungen im Rettungssystem vorausgehen: Verkürzung des Zeitintervalls bis zum Beginn von Basismaßnahmen sowie konsequente Durchführung eines gestaffelten Rettungssystems.
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  • 14
    Electronic Resource
    Electronic Resource
    Springer
    Cellular and molecular life sciences 8 (1952), S. 386-386 
    ISSN: 1420-9071
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Résumé L'auteur a déterminé la valeur de l'activité de la cytochromoxydase dans la matrice des rats dans les diverses périodes de leur vie. Il a trouvé que cette activité est plus élevée dans les jeunes animaux, et elle diminue avec la croissance du poid de la matrice et de l'âge des animaux, jusqu'à arriver à des valeurs très petites dans les matrices des animaux adultes.
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  • 15
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 16
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 17
    ISSN: 1365-2761
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Biology , Medicine
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  • 18
    ISSN: 0020-711X
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Biology , Chemistry and Pharmacology
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  • 19
    ISSN: 1434-9949
    Keywords: Diclofenac-Patient ; Preference-Compliance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Two-hundred-and-three female patients (mean age: 58 yrs; SD: 8.2 yrs) suffering from osteoarthritis entered this late phase IV multicentre, stratified according to previous therapy (e.g. ketoprofen, naproxen, aspirin, indomethacin or indoprofen), randomized, double-blind, between within-patient trial of 2-week duration. Each patient received either diclofenac SR 100 mg/day (D), piroxicam 20 mg/day (P), or placebo (P1 by oral route. Clinical evaluation (functional class; pain assessment; osteoarthritic condition; joint motility and stiffness) was performed at entry, as well as after the first and the second week. Patient compliance and reported signs and symptoms were recorded after the first week and at the end of the trial. Patient preference, as regards previous therapy, and global evaluation (both by the physicians and the patients) were checked at the end of the trial. The clinical evaluation showed a superiority of D and P over P1. No difference was seen between the two active drugs. Placebo effect was very strong. Global evaluation was significantly in favour of D and P. Patient compliance was extremely good (⩽95%). Diclofenac was preferred to naproxen, aspirin and indomethacin, while piroxicam and placebo were preferred only to aspirin. The tolerability of the two active drugs was good and comparable. A significantly lower number of patients complaining of unwanted effects (u.e.) was detected in the placebo group. The number of patients withdrawn for u.e. was similar in the three trial groups.
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  • 20
    ISSN: 1420-9071
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Summary Volatile substances from the females ofDacus oleae have been submitted to GLC-MS analysis and several components identified. E-6-nonen-1-ol and p-cymene displayed attractive and aphrodisiac effects in both laboratory and field experiments.
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