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"Am Beispiel eines innerstaedtischen Notarztsystems wurde eine prospektive Prozessanalyse auf der Basis der Definitionen des Utstein-Style \" \" durchgefuehrt . Untersucht wurden Verzoegerungen und Unterbrechungen im organisatorischen , medizinischen und medizinisch-technischen Bereich bei ausserklinischen Wiederbelebungsmassnahmen anhand eines Kollektiv von n=71 reanimationspflichtigen Patienten ."
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"Fragestellung der vorliegenden Studie war , ob die bislang immer vermutete , aber nie bewiesene Beeinflussung von Reaktionsparametern durch emotional belastete Einsatzstichworte , tatsaechlich nachweisbar ist . Die Untersuchungsmethode beruhte auf der Dokumentation von Rettungsdiensteinsaetzen und konsekutiver Analyse der Zeitintervalle \" Ausrueckzeit und \" Anfahrzeit \" \" sowie der durchschnittlichen Fahrtgeschwindigkeit der Rettungsmittel wobei die subjektive verbale Beeinflussung durch den Leitstellendisponenten durch schriftliche Depeschenalarmierung eleminiert wurde . Insgesamt konnten 4302 Einsaetze von Rettungswagen ( RTW ) und Notarztwagen ( NAW ) analysiert werden . Es zeigten sich deutlich verminderte Anfahrzeiten und Ausrueckzeiten fuer traumatische gegenueber nicht-traumatischen Notfaellen , ebenso deutlich verkuerzte Ausrueckzeiten und erhoehte Geschwindigkeiten fuer Notfaelle mit Patienten der Altersgruppe 0-6 Jahre gegenueber Patienten > 60 Jahren bzw. bei Einsaetzen in Schulen/Kindergaerten gegenueber Altenheimen . Schnellere Ausrueckzeiten konnten fuer die Tage Montag bis Donnerstag gegenueber dem Wochenende aufgezeigt werden . Die Ergebnisse sind als Indikatoren fuer den Einfluss von Einsatzstichworten und Dienstbedingungen auf die Reaktionsparameter zu sehen und beduerfen aufgrund der Auswirkungen auf die organisatorische Qualitaet der praeklinischen Notfallversorgung weiterer Evaluierung ."
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"Die Simulation in der Anaesthesie ist eine neue Technik . Full Scale-Simulatoren sind Geraete , die mit Hilfe von Modellen wichtige physiologische Eigenschaften eines Patienten exakt simulieren . Mit Hilfe dieser Modelle , einer Patientenpuppe und einer realistischen Umgebung kann bei Probanden der Eindruck des Handelns am echten Patienten erzeugt werden . Die Simulation dient der Aus- , Fort- und Weiterbildung , der Forschung und Entwicklung . Mit ihr kann medizinisches Wissen und Erfahrung ebenso vermittelt werden , wie das Management von Notfallsituationen ( Crisis Resource Management ) . Sie dient besonders der Forschung auf den Gebieten Verhalten , Ergonomie , Physiologie , Pharmakologie und Modellbildung . Die vorhandenen Geraete bieten immer noch erheblichen Raum fuer Verbesserungen und Erweiterungen . Die Simulation erfaehrt derzeit einen zahlenmaessigen Aufschwung mit weltweit etwa 90 Installationen , in Deutschland gibt es 5 Zentren mit wachsender Tendenz . Diese Zentren fuehren unter erheblichem finanziellen , organisatorischen und personellen Aufwand regelmaessig Kurse fuer eigene und externe Teilnehmer durch . Ihr Stellenwert in der Ausbildung von Anaesthesisten und anderen Medizinern ist noch nicht endgueltig definiert ."
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"In der vorliegenden Untersuchung wurde die Einrichtung eines LNA-Systems in Rheinland-Pfalz mit Stichtag 31.12.97 in Bezug auf Qualitaet und Quantitaet analysiert . In 24 Landkreisen/kreisfreien Staedten wurde ein tatsaechliches LNA-System installiert . In 7 Gebieten wurde noch kein LNA-System installiert , in 4 Faellen waren Ersatzsysteme eingerichtet , die nicht durch den Traeger legitimiert worden sind . Die Analyse der 24 existierenden LNA-Systeme zeigte , dass nur in 7 Systemen eine geregelte Einsatzbereitschaft vorhanden war , eine schriftliche Dienstordnung wurde nur in 11 Gebieten vertraglich festgehalten . Die essentiellen Hilfsmittel wie persoenliche Schutzausruestung , drahtlose Kommunikationsmoeglichkeiten , Dienstausweis und administratives Material waren nur in 3 Systemen komplett vorhanden . In 11 Systemen mussten die Leitenden Notaerzte mit ihrem Privatfahrzeug ohne Sonderrechte zum Einsatzort fahren ."
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"Untersuchungen zur Pathophysiologie des akuten ischaemischen Insultes haben gezeigt , dass optimale Bedingungen bestehen , wenn die Fruehsymptome des Schlaganfalls schnell erkannt werden und die Behandlung innerhalb von 3 h nach Einsetzen der Erstsymptome eingeleitet wird . Zwischen dem Auftreten der Symptome und Therapiebeginn geht oft wertvolle Zeit verloren . Die Symptome werden von Patienten , Verwandten oder Zeugen nicht bemerkt oder bagatellisiert . Auch von rettungsdienstlichem und medizinischen Personal wird dem Schlaganfall nur wenig Prioritaet beigemessen . Nur eine geringe Zahl von Schlaganfallpatienten wird innerhalb des oben genannten Zeitfensters notfallmedizinisch versorgt . Die Steigerung dieser Anzahl ist durch intensivierte Ausbildungsmassnahmen , die sowohl die Oeffentlichkeit als auch das notfallmedizinische Personal beruecksichtigen , zu erreichen . Der gueltige Behandlungsstandard in der Akuttherapie umfasst eine adaequate zerebrale Oxygenierung , die Behandlung von Herzrhythmusstoerungen , das Blutdruck-Management sowie die Therapie von Hyperglykaemie und Hyperthermie . Der Schlaganfallpatient sollte fruehzeitig bei der aufnehmenden Klinik angemeldet werden , um die Aufnahme durch ein spezielles Stroke-Team zu ermoeglichen ."
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Notfall+Rettungsmedizin.90020422.ger.abstr | Notfall+Rettungsmedizin.90020422.ger.abstr | [
{
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"Einerseits koennen akute zerebrale Laesionen kardiale Arrhythmien hervorrufen , andererseits sind akute kardiale Ereignisse mit zerebralen Komplikationen vergesellschaftet . Beide Faktoren tragen gemeinsam dazu bei , dass kardiale Ereignisse wie ploetzlicher Herztod und akuter Myokardinfarkt die fuehrenden Todesursachen im Langzeitverlauf des Hirninfarktes sind . Fortschritte im Verstaendnis der Neurophysiologie kardiovaskulaerer Kontrollmechanismen haben in den letzten Jahren die Bedeutung des Zentralen Nervensystems fuer die Entwicklung schwerwiegender kardialer Dysfunktionen erkennen lassen . Die Literatur der letzten 5 Jahre beschaeftigt sich ganz ueberwiegend mit dem Thema der kardialen Emboliequellen als Ursache des Hirninfarktes . Inhalt dieses Artikels sollen jedoch im wesentlichen die neurokardialen Effekte des Hirninfarktes sein . Dies erscheint uns deshalb von besonderem Interesse , weil die Erkenntnisse ueber die neurogenen arrhythmogenen Einfluesse im Rahmen des Schlaganfalls ein EKG-Monitoring implizieren , um neu oder nur paroxysmal auftretende Arrhythmien rasch zu erkennen , zu therapieren und damit die Mortalitaet des Hirninfarktes moeglicherweise zu senken ."
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Notfall+Rettungsmedizin.90020428.ger.abstr | Notfall+Rettungsmedizin.90020428.ger.abstr | [
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"Der Schlaganfall und seine Folgen stellen in medizinischer , gesellschaftlicher und soziooekonomischer Hinsicht eine der groessten Herausforderungen unserer Zeit dar . Aufgrund der demographischen Entwicklung wird diesem Krankheitsbild zukuenftig noch eine wesentlich groessere Bedeutung zukommen . Ungeachtet dieser Aspekte war die Akutversorgung des ischaemischen Schlaganfalls bis heute eher von therapeutischem Nihilismus und dem Festhalten an empirisch ermittelten Therapieverfahren gekennzeichnet . Erst die 1996 in den USA erfolgte Zulassung von rt-PA zur systemischen Thrombolyse bei weniger als 3 Stunden altem ischaemischen Insult sowie die Verbesserung der bildgebenden Verfahren fuehrte zu einer Aenderung therapeutischer Strategien . Das guenstige Nutzen-Risiko-Verhaeltnis der fruehen Thrombolyse mit rt-PA wurde juengst in weiteren Untersuchungen bestaetigt . Mittlerweile wird diese Therapie u.a. von der AHA offiziell im Range einer Grade A Recommendation empfohlen . Auch in Europa wird die Thrombolyse seit kurzem als Verfahren der Wahl propagiert . Derzeit werden nur wenige Patienten einer derartigen Therapie zugefuehrt : Momentan kann eine Lysetherapie aufgrund der hohen Anforderungen an die Infrastruktur nur an wenigen Zentren durchgefuehrt werden . Ueberdies erfolgt die Klinikaufnahme oftmals mit erheblicher zeitlicher Verzoegerung . Ungluecklicherweise sind auch innerhalb der Klinik erhebliche Latenzen bis zum Therapiebeginn zu verzeichnen . Grundvoraussetzung der Lysetherapie ist es demnach , bereits praeklinisch die potentiell geeigneten Patienten zu identifizieren und so rasch wie moeglich in eine hierfuer geeignete Klinik zu transferieren ."
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Notfall+Rettungsmedizin.90020436.ger.abstr | Notfall+Rettungsmedizin.90020436.ger.abstr | [
{
"id": "Notfall+Rettungsmedizin.90020436.ger.abstr-passage-0",
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"Zusammenfassung Der Mainz Emergency Evaluation Score ( MEES ) hat sich als Instrument zur Ueberpruefung der Ergebnisqualitaet in der Notfallmedizin bewaehrt . Eine Grenze der Anwendbarkeit stellen jedoch Notfaelle im Kindesalter dar , weil die dem MEES hinterlegten physiologischen Daten diesen Altersklassen nicht immer entsprechen . Dies gilt insbesondere fuer die Beurteilung von Atmung und Kreislauf . Zur Uebertragung des MEES-Konzeptes auf Notfaelle im Kindesalter werden fuer die Herzfrequenz altersspezifische Grenzwerte festgelegt . Die Blutdruckmessung kann im Kindesalter durch die Dokumentation der Pulsstaerke , die Atemfrequenz durch die inspektorische Suche nach Zeichen der respiratorischen Insuffizienz ersetzt werden . Dem Notarzt werden somit einfache Kriterien zur Beurteilung des Verlaufs der Vitalfunktionen zur Verfuegung gestellt , wobei die Anforderungen des MEES beruecksichtigt werden und der Aufwand der Dokumentation nur unwesentlich erweitert wird ."
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"Die enormen technischen Fortschritte im Bereich der mobilen Kommunikation sind im taeglichen Leben allgegenwaertig . Die Weiterentwicklung der entsprechenden notfallmedizinischen Infrastruktur sowie des organisatorischen und rechtlichen Umfeldes hinken jedoch den technischen Moeglichkeiten hinterher . Gerade in der Notfallmedizin kann aber davon ausgegangen werden , dass telemedizinische und telematische Applikationen zu deutlichen Veraenderungen der Handlungsablaeufe fuehren . Bestehende Schwachstellen im Bereich des Notfallmanagements , die Belange des Qualitaetsmanagements und nicht zuletzt auch oekonomische Betrachtungen liefern eine Vielzahl von Ansatzpunkten fuer den Telematikeinsatz in der Notfallmedizin . In zahlreichen Projekten konnten teilweise beeindruckende Effekte gezeigt werden . Diese erstrecken sich auf alle Glieder der Rettungskette : Homemonitoring , automatische Notrufsysteme , Telematikapplikationen in Rettungsleitstellen und der mobile Einsatz in den Rettungsmitteln . Unsere Aufgabe ist es nun , bestehende Schwachstellen in der Notfallmedizin zu analysieren , die tatsaechlichen Anforderungen an die Technik zu formulieren und unterschiedliche Loesungsansaetze zu evaluieren und ggf. zu integrieren ."
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}
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"text": [
"Gliedmasse"
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]
}
] | [] | [] | [] |
OperativeOrthopaedie.00120234.ger.abstr | OperativeOrthopaedie.00120234.ger.abstr | [
{
"id": "OperativeOrthopaedie.00120234.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Operationsziel Der patellotibiale Fixateur dient dem voruebergehenden Schutz eines rekonstruierten distalen Kniegelenkstreckapparates und bietet den Vorteil einer fruehen funktionellen postoperativen Behandlung ."
],
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0,
212
]
]
}
] | [
{
"id": "OperativeOrthopaedie.00120234.ger.abstr-s1-t1",
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"text": [
"Kniegelenkstreckapparates"
],
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108,
133
]
],
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"db_name": "UMLS",
"db_id": "C0022745"
}
]
},
{
"id": "OperativeOrthopaedie.00120234.ger.abstr-s1-t2",
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"Behandlung"
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200,
210
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0039796"
}
]
}
] | [] | [] | [
{
"id": "OperativeOrthopaedie.00120234.ger.abstr-s1-r1-t1.1-t2.1",
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"arg1_id": "OperativeOrthopaedie.00120234.ger.abstr-s1-t1",
"arg2_id": "OperativeOrthopaedie.00120234.ger.abstr-s1-t2",
"normalized": []
}
] |
OperativeOrthopaedie.00120247.ger.abstr | OperativeOrthopaedie.00120247.ger.abstr | [
{
"id": "OperativeOrthopaedie.00120247.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Operationsziel Minimal invasive Entfernung der Bursa trochanterica , gegebenenfalls mit Exostosenresektion und/oder Traktopexie am Trochanter major ."
],
"offsets": [
[
0,
149
]
]
}
] | [
{
"id": "OperativeOrthopaedie.00120247.ger.abstr-s1-t1",
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131,
141
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],
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{
"db_name": "UMLS",
"db_id": "C0162370"
}
]
}
] | [] | [] | [] |
OperativeOrthopaedie.90110255.ger.abstr | OperativeOrthopaedie.90110255.ger.abstr | [
{
"id": "OperativeOrthopaedie.90110255.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Operationsziel Schmerzfreiheit und Wiederherstellung der Schultergelenkfunktion ."
],
"offsets": [
[
0,
81
]
]
}
] | [
{
"id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t1",
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{
"id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t2",
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15,
30
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]
},
{
"id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t3",
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"text": [
"Wiederherstellung"
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35,
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],
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"db_name": "UMLS",
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}
]
},
{
"id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t4",
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"text": [
"Schultergelenkfunktion"
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57,
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]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0037009"
}
]
}
] | [] | [] | [
{
"id": "OperativeOrthopaedie.90110255.ger.abstr-s1-r1-t3.1-t1.1",
"type": "co-occurs_with",
"arg1_id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t3",
"arg2_id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t1",
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},
{
"id": "OperativeOrthopaedie.90110255.ger.abstr-s1-r2-t4.1-t2.1",
"type": "isa",
"arg1_id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t4",
"arg2_id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t2",
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},
{
"id": "OperativeOrthopaedie.90110255.ger.abstr-s1-r3-t3.1-t2.1",
"type": "isa",
"arg1_id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t3",
"arg2_id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t2",
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},
{
"id": "OperativeOrthopaedie.90110255.ger.abstr-s1-r4-t1.1-t3.1",
"type": "co-occurs_with",
"arg1_id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t1",
"arg2_id": "OperativeOrthopaedie.90110255.ger.abstr-s1-t3",
"normalized": []
}
] |
OperativeOrthopaedie.90110268.ger.abstr | OperativeOrthopaedie.90110268.ger.abstr | [
{
"id": "OperativeOrthopaedie.90110268.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Operationsziel Uebungsstabile Osteosynthese des Humerus mit solidem , intramedullaeren Verriegelungsmarknagel in nichtaufgebohrter Technik ."
],
"offsets": [
[
0,
140
]
]
}
] | [
{
"id": "OperativeOrthopaedie.90110268.ger.abstr-s1-t1",
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"text": [
"Humerus"
],
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48,
55
]
],
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"db_name": "UMLS",
"db_id": "C0020164"
}
]
},
{
"id": "OperativeOrthopaedie.90110268.ger.abstr-s1-t2",
"type": "umlsterm",
"text": [
"Technik"
],
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131,
138
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0039421"
}
]
}
] | [] | [] | [
{
"id": "OperativeOrthopaedie.90110268.ger.abstr-s1-r1-t1.1-t2.1",
"type": "issue_in",
"arg1_id": "OperativeOrthopaedie.90110268.ger.abstr-s1-t1",
"arg2_id": "OperativeOrthopaedie.90110268.ger.abstr-s1-t2",
"normalized": []
}
] |
OperativeOrthopaedie.90110296.ger.abstr | OperativeOrthopaedie.90110296.ger.abstr | [
{
"id": "OperativeOrthopaedie.90110296.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Operationsziel Indirekte Reposition von subtrochantaeren Frakturen ueber die Ligamentotaxis ohne chirurgische Traumatisierung der Frakturzone ( keine devaskularisierten Fragmente ! ) und uebungsstabile Osteosynthese mit einer Kondylenplatte ."
],
"offsets": [
[
0,
242
]
]
}
] | [
{
"id": "OperativeOrthopaedie.90110296.ger.abstr-s1-t1",
"type": "umlsterm",
"text": [
"Frakturen"
],
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57,
66
]
],
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{
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"db_id": "C0016658"
}
]
},
{
"id": "OperativeOrthopaedie.90110296.ger.abstr-s1-t2",
"type": "umlsterm",
"text": [
"Frakturzone"
],
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[
130,
141
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0016658"
}
]
}
] | [] | [] | [] |
OperativeOrthopaedie.90110319.ger.abstr | OperativeOrthopaedie.90110319.ger.abstr | [
{
"id": "OperativeOrthopaedie.90110319.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Operationsziel Beseitung der kontrakten Krallenzehstellung der Zehen II bis IV durch Arthrodese des proximalen Interphalangealgelenkes ( PIP-Gelenk ) und Reposition des Metatarsophalangealgelenkes ( MTP-Gelenk ) ."
],
"offsets": [
[
0,
213
]
]
}
] | [
{
"id": "OperativeOrthopaedie.90110319.ger.abstr-s1-t1",
"type": "umlsterm",
"text": [
"Zehen"
],
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[
63,
68
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0040357"
}
]
},
{
"id": "OperativeOrthopaedie.90110319.ger.abstr-s1-t2",
"type": "umlsterm",
"text": [
"Arthrodese"
],
"offsets": [
[
85,
95
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0003881"
}
]
}
] | [] | [] | [
{
"id": "OperativeOrthopaedie.90110319.ger.abstr-s1-r1-t1.1-t2.1",
"type": "location_of",
"arg1_id": "OperativeOrthopaedie.90110319.ger.abstr-s1-t1",
"arg2_id": "OperativeOrthopaedie.90110319.ger.abstr-s1-t2",
"normalized": []
}
] |
PerinatalMedizin.60080009.ger.abstr | PerinatalMedizin.60080009.ger.abstr | [
{
"id": "PerinatalMedizin.60080009.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Zusammenfassung . Kontrollierte klinische Studien haben gezeigt , dass die Behandlung mit Surfactant die Mortilitaet , die Inzidenz des Pneumothorax und ( wahrscheinlich ) die Inzidenz der bronchopulmonalen Dysplasie bei sehr unreifen Fruehgeburten senkt . Der Beatmungsaufwand kann durch Surfactanttherapie verringert werden . Wir analysierten , ob sich die Ergebnisse klinischer Studien auch unter Routinebedingungen erreichen liessen , ob zunehmend bessere Ergebnisse im Sinne einer learning curve \" \" erzielt wurden und ob sie von der Abteilungsgroesse oder einem Transport nach der Geburt beeinflusst wurden . Population : Alle 760 surfactantbehandelten Neugeborenen 1500 g Geburtsgewicht , die von 1990 bis 1992 in einem Krankenhaus aufgenommen wurden , das an der Neonatalerhebung Westfalen-Lippe teilnimmt . Zielgroessen : Messgroessen fuer den Beatmungsaufwand waren die Haeufigkeit von Rachen-CPAP , Sauerstoffgabe > 30% an mehr als 28 d und eine Intubationsdauer von mehr als 14 d . Weitere Messgroessen waren Mortalitaet , bronchopulmonale Dysplasie , bronchopulmonale Dysplasie bei Ueberlebenden , Pneumothorax , persistierender Ductus arteriosus , intraventrikulaere Haemorrhagie Grad III-IV und Retinopathia praematurorum bei Ueberlebenden . Daneben wurden die Ergebnisse fuer Neugeborene aus Kliniken mit kleinen und grossen Patientenzahlen und die Ergebnisse fuer in die Klinik geborene Kinder und Kinder , die nach der Geburt transportiert werden mussten , verglichen . Ergebnisse : Abgesehen von einer geringeren Inzidenz des persistierenden Ductus arteriosus in der Neonatalerhebung Westfalen-Lippe beobachten wir aehnliche Ergebnisse wie in einer akutellen Metaanalyse . Seit der Zulassung von Surfactantpraeparaten in 1990 stellten wir eine Verbesserung der Ergebnisse bezogen auf Mortalitaet , Ueberleben ohne bronchopulmonale Dysplasie und die Inzidenzen pulmonaler Komplikationen wie der bronchopulmonalen Dysplasie und des Pneumothorax fest . Auch der Beatmungsaufwand ging zurueck . Die Ergebnisse in Krankenhaeusern mit kleinen und grossen Patientenzahlen unterschieden sich nicht . Kinder , die nach der Geburt transportiert werden mussten , hatten ein groesseres Risiko , an bronchopulmonaler Dysplasie zu erkranken . Schlussfolgerung : Im Bereich der Neonatalerhebung Westfalen-Lippe wurden nach allgemeiner Verfuegbarkeit der Surfactanttherapie 1990-1992 aehnliche Ergebnisse wie in einer aktuellen Metaanalyse klinischer Studien erzielt ."
],
"offsets": [
[
0,
2471
]
]
}
] | [
{
"id": "PerinatalMedizin.60080009.ger.abstr-s2-t1",
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"Behandlung"
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75,
85
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],
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{
"id": "PerinatalMedizin.60080009.ger.abstr-s2-t2",
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"Inzidenz"
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123,
131
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],
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}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s2-t3",
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"text": [
"Pneumothorax"
],
"offsets": [
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136,
148
]
],
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"db_name": "UMLS",
"db_id": "C0032326"
}
]
},
{
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"Inzidenz"
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176,
184
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],
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"db_name": "UMLS",
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}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s2-t5",
"type": "umlsterm",
"text": [
"Fruehgeburten"
],
"offsets": [
[
235,
248
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0021294"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s4-t1",
"type": "umlsterm",
"text": [
"Geburt"
],
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587,
593
]
],
"normalized": [
{
"db_name": "UMLS",
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}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s5-t1",
"type": "umlsterm",
"text": [
"Population"
],
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[
615,
625
]
],
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}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s5-t2",
"type": "umlsterm",
"text": [
"Geburtsgewicht"
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"offsets": [
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679,
693
]
],
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},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s5-t3",
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"Krankenhaus"
],
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727,
738
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],
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},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s5-t4",
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"Westfalen-Lippe"
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788,
803
]
],
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"db_id": "C0023759"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s6-t1",
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"text": [
"Sauerstoffgabe"
],
"offsets": [
[
910,
924
]
],
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"db_name": "UMLS",
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},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s7-t1",
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"text": [
"Mortalitaet"
],
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1021,
1032
]
],
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{
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}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s7-t2",
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"Pneumothorax"
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1111,
1123
]
],
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}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s7-t3",
"type": "umlsterm",
"text": [
"Haemorrhagie"
],
"offsets": [
[
1181,
1193
]
],
"normalized": [
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"db_name": "UMLS",
"db_id": "C0019080"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s7-t4",
"type": "umlsterm",
"text": [
"Ductus arteriosus"
],
"offsets": [
[
1142,
1159
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0013273"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s7-t5",
"type": "umlsterm",
"text": [
"Retinopathia praematurorum"
],
"offsets": [
[
1210,
1236
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0035344"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s8-t1",
"type": "umlsterm",
"text": [
"Patientenzahlen"
],
"offsets": [
[
1341,
1356
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0030705"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s8-t2",
"type": "umlsterm",
"text": [
"Kinder"
],
"offsets": [
[
1404,
1410
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0008059"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s8-t3",
"type": "umlsterm",
"text": [
"Kinder"
],
"offsets": [
[
1415,
1421
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0008059"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s8-t4",
"type": "umlsterm",
"text": [
"Geburt"
],
"offsets": [
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1437,
1443
]
],
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"db_name": "UMLS",
"db_id": "C0005615"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s9-t1",
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"text": [
"Inzidenz"
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1532,
1540
]
],
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"db_name": "UMLS",
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}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s9-t2",
"type": "umlsterm",
"text": [
"Westfalen-Lippe"
],
"offsets": [
[
1603,
1618
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0023759"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s9-t3",
"type": "umlsterm",
"text": [
"Metaanalyse"
],
"offsets": [
[
1678,
1689
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0282458"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s9-t4",
"type": "umlsterm",
"text": [
"Ductus arteriosus"
],
"offsets": [
[
1561,
1578
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0013273"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s10-t1",
"type": "umlsterm",
"text": [
"Zulassung"
],
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[
1701,
1710
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0023637"
}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s10-t2",
"type": "umlsterm",
"text": [
"Mortalitaet"
],
"offsets": [
[
1803,
1814
]
],
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"db_name": "UMLS",
"db_id": "C0026566"
},
{
"db_name": "UMLS",
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}
]
},
{
"id": "PerinatalMedizin.60080009.ger.abstr-s10-t3",
"type": "umlsterm",
"text": [
"Inzidenzen"
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1868,
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],
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"db_name": "UMLS",
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PerinatalMedizin.60080015.ger.abstr | PerinatalMedizin.60080015.ger.abstr | [
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"id": "PerinatalMedizin.60080015.ger.abstr-passage-0",
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"Zusammenfassung . Im Verlauf der Jahre 1983 bis 1992 lag der Anteil von Fruehgeborenen , d.h. der Neugeborenen mit einem Geburtsgewicht unter 2500 g , in der Bundesrepublik Deutschland konstant bei rund 5,8% . Die perinatatale Mortalitaet dieser Patientengruppe lag zuletzt bei 5,8% , bei einer gesamtem perinatalen Mortalitaet von 0,58% . In den verschiedenen Gewichtsklassen findet sich waehrend der vergangenen 10 Jahre eine stete Abnahme der perinatalen Sterblichkeit , mit Ausnahme der extrem unreifen Fruehgeborenen mit einem Geburtsgewicht unter 500 g , bei denen keine eindeutige Tendenz in diesem Zeitraum zu erkennen ist ; sie lag 1992 bei 91,2% . Die perinatale Mortalitaet der Lebendgeborenen mit einem Geburtsgewicht zwischen 500 g und 1500 g nahm in dem berichteten Zeitraum von 26,5% auf 13,3% ab ; bis zum Ende des ersten Lebensjahres waren 1992 rund ein Fuenftel aller Lebendgeborenen verstorben ."
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PerinatalMedizin.60080019.ger.abstr | PerinatalMedizin.60080019.ger.abstr | [
{
"id": "PerinatalMedizin.60080019.ger.abstr-passage-0",
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"text": [
"Zusammenfassung . Anhand eines Fallberichts wird ueber die Diagnostik einer postpartalen Thrombose der linken Ovarialvene unter Beteiligung der Vena renalis sinistra mittels Computertomographie berichtet . Nach konservativem Therapieversuch wurde diese schwere Wochenbettkomplikation operativ unter interdisziplinaerer Zusammenarbeit mit dem Gefaesschirurgen erfolgreich behandelt ."
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"Zusammenfassung . In der Literatur findet sich nur eine begrenzte Zahl von Arbeiten ueber Oxytocin- ( OT ) bestimmung in der Schwangerschaft , unter der Geburt und im Wochenbett , da nur wenige Zentren in der Lage sind , OT im muetterlichen Blut zu messen . Nach Aufbau eines OT-Rias haben wir daher bei insgesamt 60 Frauen 110 OT-Plasmabestimmungen durchgefuehrt und zwar bei 15 Schwangeren mit Fruehgeburtsgefaehrdung in der 25.-35. Schwangerschaftswoche , 18 Frauen unter der Geburt , 9 in der Nachgeburtsperiode , 9 im Wochenbett und 9 vor und waehrend des Stillens . Die OT-Konzentrationen , angegeben als Medianwert im Zusammenhang mit der 16. und 84. Perzentile , lagen bis zur Woche 32/0 bei 13,4 pg/ml ( 10,9- 15,5 ) , ab 32/1 bei 13,9 pg/ml 13- 17,4 ) . ( Waehrend das Gestationsalter also keinen Einfluss auf die OT-Werte nahm , fanden sich signifikant erhoehte OT-Werte bei Frauen mit vorzeitig gereifter Zervix und nachfolgender Fruehgeburt ( Median 15,2 pg/ml ) . Unter der Geburt stiegen die Werte nur im Vergleich zu Frauen mit erhaltener Zervix in graviditate signifikant an . Dabei wiesen Patientinnen mit raschem Geburtsverlauf ( =6 h signifikant niedrigere OT-Werte ) auf als Frauen mit langsamen Verlauf ( > =7 h ) ( 14,2 vs. 16,1 pg/ml ) . In der Nachgeburtsperiode 5-15 min post partum und in den ersten 3 Wochenbettstagen fanden sich mit 18,9 pg/ml die hoechsten OT-Werte ueberhaupt . Vor und waehrend des Stillens veraenderten sich die OT-Werte nicht . Hohe OT-Werte scheinen in der Schwangerschaft und unter der Geburt ein prognostisch unguenstiges Zeichen darzustellen . Sie sind in der Schwangerschaft mit einer Fruehgeburtsgefaehrdung und unter der Geburt mit einem langsamen Verlauf korreliert ."
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PerinatalMedizin.60080044.ger.abstr | PerinatalMedizin.60080044.ger.abstr | [
{
"id": "PerinatalMedizin.60080044.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Zusammenfassung . In Form einer Kasuistik wird der Verlauf eines Neugeborenen mit einer funktionslosen Niere geschildert . Die Diagnose wurde in den letzten beiden Schwangerschaftswochen durch Sonographie und fetale Urinanalyse vermutet . Die postnatalen Befunde liessen zunaechst eine Restfunktion erwarten , die sich jedoch nach Urindeviation nicht stabilisierte . Der pathologisch-histologische Befund wird dem klinischen Verlauf gegenuebergestellt und die erhobenen Parameter als prognostische Indices zur Nierenfunktion gewertet ."
],
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0,
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PerinatalMedizin.60080053.ger.abstr | PerinatalMedizin.60080053.ger.abstr | [
{
"id": "PerinatalMedizin.60080053.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Zusammenfassung . Pleuraempyeme bei Neugeborenen sind sehr selten . Wir berichten ueber einen reifgeborenen Knaben mit einer unilateralen chronischen granulierenden fibrinoes-eitrigen Pleuritis . Klinisch imponierte die respiratorische Insuffizienz infolge der Lungenkompression , welche nur durch eine ausgedehnte Dekorti-kation zu beherrschen war . Verlauf und Befunde weisen auf eine intrauterine haematogene Infektion des Feten hin . Die Mutter des Kindes war in der letzten Schwangerschaftswoche an einem fieberhaften Infekt mit Gastroenteritis erkrankt . Am zweiten Wochenbettag wurde eine schwere abszedierende Myometritis mit generalisierter Sepsis diagnostiziert , die eine Hysterektomie erforderte ."
],
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709
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]
}
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184,
193
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261,
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220,
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412,
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"Feten"
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426,
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"Mutter"
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453,
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"id": "PerinatalMedizin.60080053.ger.abstr-s7-t1",
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"id": "PerinatalMedizin.60080053.ger.abstr-s7-t2",
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683,
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],
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] | [] | [] | [
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PerinatalMedizin.60080058.ger.abstr | PerinatalMedizin.60080058.ger.abstr | [
{
"id": "PerinatalMedizin.60080058.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Zusammenfassung . Es wird ueber den seltenen Fall einer massiven bulloesen Lymphangiohaemangiomatose der rechten oberen Extremitaet und der rechten Thorax- und Abdomenhaelfte berichtet , welche erstmals mit 28 SSW sonographisch diagnostiziert wurde . Die praenatale Diagnose , das geburtshilfliche Management und der neonatologische Verlauf werden diskutiert ."
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"Extremitaet"
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"oberen Extremitaet"
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PerinatalMedizin.60080076.ger.abstr | PerinatalMedizin.60080076.ger.abstr | [
{
"id": "PerinatalMedizin.60080076.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Zusammenfassung . Die vorliegende Untersuchung an Myometriumzellen von schwangeren Ratten beinhaltet eine erste Evaluierung einer moeglichen Interaktion zwischen -Mimetika bzw. -Blockern , Substanzen , die ja bekannterweise ueber die Bindung an -Adrenozeptoren zu einer Induktion bzw. Hemmung von zyklischen Adenosinmonophosphat ( cAMP ) fuehren , und der Bildung von Stickstoffmonoxid ( NO ) . Von je 7 Ratten am Tag 17 der Schwangerschaft ( SS ) bzw. sub partu wurde der Uterus entnommen und jeweils 100-mg-Streifen wurden mit Ritodrin bzw. Propranolol in je 2 Konzentrationen ( 10-3 M , 10-7 M in Kulturmedium ) bzw. einer Kontrolloesung ( Kulturmedium ohne Zusatz ) waehrend 24 h inkubiert ( 37 Grad C , 5% CO2). Nach der Inkubation wurde in den Kulturmedien die Gesamtkonzentration an Nitriten bestimmt . Im Vergleich zur Kontrolle wurde unter Ritodrin 10-3 M im Medium der schwangeren Ratten vom Tag 17 ein Anstieg der Nitritkonzentration festgestellt ( 264,14 +/- 124,58 vs. 180,03 +/- 89,4 nmol/g , n . s. ) , hingegen wies das mit Propranolol 10-3 M inkubierte Medium im Vergleich zur Kontrolle eine deutlich erniedrigte Nitritkonzentration auf ( Tag 17 : 112,93 +/- 50,32 vs. 180,03 +/- 89,4 nmol/g , n . s. ; sub partu : 65,48 +/- 25,28 vs. 260,48 +/- 196,76 nmol/g , p 0,05 ) ; jeweils Mittelwert +/- Standardabweichung ( n = 7 ) . Diese vorlaeufigen Ergebnisse lassen die Vermutung zu , dass zwischen dem ueber das -Adrenozeptorsystem gebildeten cAMP und der NO-Bildung im Rattenmyometrium eine Interaktion existiert ."
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PerinatalMedizin.60080079.ger.abstr | PerinatalMedizin.60080079.ger.abstr | [
{
"id": "PerinatalMedizin.60080079.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Zusammenfassung . Ziel der vorliegenden Studie war es , den Einfluss von Gestoseserum auf die Expression von t-PA und PAI-1 aus humanen Endothelzellkulturen zu untersuchen . Hierzu wurden humane Endothelzellen aus Nabelvenen ( HUVEC ) kultiviert und fuer 24 h mit Serum von 7 Patientinnen mit HELLP-Syndrom und 12 Patientinnen mit Praeeklampsie stimuliert . Als Kontrolle dienten die Seren von 12 normotensiven Schwangeren und 9 Nichtschwangeren . Anschliessend erfolgte die Bestimmung von t-PA und PAI-1 mittels ELISA sowohl mit muetterlichen Serum , als auch im Ueberstand der Endothelzellkulturen . Waehrend t-PA im Maternalen Serum bei Gestosepatientinnen und Patientinen mit HELLP-Syndrom signifikant gegenueber den Kontrollpatientinnen erhoeht war ( Median 8,0 : ng/ml und 6,2 ng/ml vs 3,9 ng/ml und 3,1 ng/ml ) , zeigten sich fuer die PAI-1 Konzentrationen keine signifikanten Unterschiede in den einzelnen Gruppen . Im Ueberstand der Endothelzellkulturen traten nach Stimulation mit Gestoseserum signifikant hoehere Werte , sowohl fuer t-PA ( p 0,001 ) als auch fuer PAI-1 ( p 0,01 ) auf . Die gesteigerte Expression von t-PA und PAI-1 aus humanen Endothelzellen nach Stimulation mit Serum von Gestosepatientinnen muss als Ausdruck der gesteigerten Endothelzellaktivierung gewertet werden ."
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"id": "PerinatalMedizin.60080079.ger.abstr-s8-r3-t2.1-t3.1",
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"arg2_id": "PerinatalMedizin.60080079.ger.abstr-s8-t3",
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PerinatalMedizin.60080081.ger.abstr | PerinatalMedizin.60080081.ger.abstr | [
{
"id": "PerinatalMedizin.60080081.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Zusammenfassung . Die persistierende pulmonale Hypertension ( PPHN ) ist eine Komplikation des schweren respiratorischen Versagens im Neugeborenenalter , die mit einer hohen Morbiditaet und Mortalitaet verbunden ist . Oft stellt die extrakorporale Membranoxygenierung ( ECMO ) die letzte Therapieoption dar . Seit 3 Jahren geben Berichte ueber die er-folgreiche Anwendung von inhalativem NO ( iNO ) Anlass zum Optimismus in der Behandlung der PPHN . Wir untersuchten an unserer Klinik in einer Pilotstudie die Wirkung von iNO bei Neu- und Fruehgeborenen und PPHN ."
],
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0,
564
]
]
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47,
59
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78,
90
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"id": "PerinatalMedizin.60080081.ger.abstr-s2-t3",
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"Neugeborenenalter"
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134,
151
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"db_name": "UMLS",
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"Morbiditaet"
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174,
185
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"db_id": "C0026538"
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190,
201
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"db_id": "C0026566"
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}
]
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"type": "umlsterm",
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"pulmonale Hypertension"
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37,
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"db_id": "C0020542"
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"ECMO"
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270,
274
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"text": [
"Therapieoption"
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288,
302
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"type": "umlsterm",
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"Behandlung"
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428,
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"db_name": "UMLS",
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] | [] | [] | [
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"id": "PerinatalMedizin.60080081.ger.abstr-s2-r7-t1.1-t2.1",
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{
"id": "PerinatalMedizin.60080081.ger.abstr-s2-r8-t2.1-t6.1",
"type": "degree_of",
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"arg2_id": "PerinatalMedizin.60080081.ger.abstr-s2-t6",
"normalized": []
},
{
"id": "PerinatalMedizin.60080081.ger.abstr-s2-r9-t2.1-t1.1",
"type": "associated_with",
"arg1_id": "PerinatalMedizin.60080081.ger.abstr-s3-t2",
"arg2_id": "PerinatalMedizin.60080081.ger.abstr-s4-t1",
"normalized": []
},
{
"id": "PerinatalMedizin.60080081.ger.abstr-s2-r10-t4.1-t2.1",
"type": "property_of",
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"arg2_id": "PerinatalMedizin.60080081.ger.abstr-s3-t2",
"normalized": []
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{
"id": "PerinatalMedizin.60080081.ger.abstr-s2-r11-t1.1-t2.1",
"type": "associated_with",
"arg1_id": "PerinatalMedizin.60080081.ger.abstr-s4-t1",
"arg2_id": "PerinatalMedizin.60080081.ger.abstr-s3-t2",
"normalized": []
},
{
"id": "PerinatalMedizin.60080081.ger.abstr-s2-r12-t6.1-t2.1",
"type": "degree_of",
"arg1_id": "PerinatalMedizin.60080081.ger.abstr-s2-t6",
"arg2_id": "PerinatalMedizin.60080081.ger.abstr-s3-t2",
"normalized": []
}
] |
PerinatalMedizin.60080084.ger.abstr | PerinatalMedizin.60080084.ger.abstr | [
{
"id": "PerinatalMedizin.60080084.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Zusammenfassung . Aktive Glukokortikosteroide ( GCS wie Kortisol und Kortikosteron ) sind fuer die Induktion der fetalen Surfactantsynthese von zentraler Bedeutung . Im fetalen Serum finden sich jedoch ueberwiegend die biologisch inaktiven Metaboliten Kortison und 11-Dehydrokortikosteron . In dieser Studie konnte an Lungenorganoidkulturen der fetalen Ratte gezeigt werden , dass die dominierende reduktive Enzymaktivitaet der 11-Hydroxysteroid-Dehydrogenase ( 11-HSD ) die intrazellulaere Konversion der inaktiven zu biologisch aktiven GCS katalysiert . Wird die 11-HSD spezifisch durch das Lakritze-Extrakt Glyzyrrhetinsaeure inhibiert , so unterbleibt dieser zentrale Stoffwechsel . Gestaerkt wird der Aktivierungsmechanismus durch GCS selbst , die zu einer Induktion der 11-HSD fuehren und somit ihre eigene Aktivierung durch positive Rueckkopplung foerdern ."
],
"offsets": [
[
0,
864
]
]
}
] | [
{
"id": "PerinatalMedizin.60080084.ger.abstr-s2-t1",
"type": "umlsterm",
"text": [
"Kortisol"
],
"offsets": [
[
56,
64
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0020268"
}
]
},
{
"id": "PerinatalMedizin.60080084.ger.abstr-s4-t1",
"type": "umlsterm",
"text": [
"Ratte"
],
"offsets": [
[
353,
358
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0034693"
}
]
},
{
"id": "PerinatalMedizin.60080084.ger.abstr-s4-t2",
"type": "umlsterm",
"text": [
"Enzymaktivitaet"
],
"offsets": [
[
408,
423
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0014442"
}
]
},
{
"id": "PerinatalMedizin.60080084.ger.abstr-s5-t1",
"type": "umlsterm",
"text": [
"Lakritze-Extrakt"
],
"offsets": [
[
593,
609
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0086555"
}
]
},
{
"id": "PerinatalMedizin.60080084.ger.abstr-s5-t2",
"type": "umlsterm",
"text": [
"Stoffwechsel"
],
"offsets": [
[
672,
684
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0025519"
},
{
"db_name": "UMLS",
"db_id": "C0025520"
}
]
},
{
"id": "PerinatalMedizin.60080084.ger.abstr-s6-t1",
"type": "umlsterm",
"text": [
"selbst"
],
"offsets": [
[
740,
746
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0036588"
}
]
},
{
"id": "PerinatalMedizin.60080084.ger.abstr-s6-t2",
"type": "umlsterm",
"text": [
"Rueckkopplung"
],
"offsets": [
[
840,
853
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0015744"
}
]
}
] | [] | [] | [] |
PerinatalMedizin.60080088.ger.abstr | PerinatalMedizin.60080088.ger.abstr | [
{
"id": "PerinatalMedizin.60080088.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Zusammenfassung . Ziel dieser retrospektiven Studie war es , die Haeufigkeit , Aetiologie und Prognose von schweren konnatalen Anaemien bei Frueh- und Neugeborenen zu untersuchen . Alle vom 01.01.1985- 31.12.1994 in der Universitaetsfrauenklinik Kiel geborenen Neu- und Fruehgeborenen wurden in die Untersuchung aufgenommen . Von 18 637 Lebendgeborenen zeigten 18 ( 0,98 permil ) Neugeborene Geburtsgewicht ( 680- 4 050 ( g , SSA 26-41 Wochen ) einen initialen Haemoglobinwert unter 10 g/dl . Bei den Kindern mit einem Geburtsgewicht unter 2 500 g lag die Haeufigkeit bei 6,8 permil . Bei 17 von 18 Neu- und Fruehgeborenen gelang die aetiologische Klaerung der Anaemie . Bei 5/18 ( 28% ) Fruehgeborenen war eine akute fetofetale Transfusion und bei 3/18 eine fetomaternale Transfusion fuer die Anaemie verantwortlich . Bei je 2 Kindern bestand die Ursache in einer Rh-Inkompatibilitaet , einer Plazentablutung oder einer Tumorblutung beim Feten . Ein Neugeborenes hatte eine schwere disseminierte Darmblutung unklarer Genese . Bei je einem Neugeborenen konnte eine EBV-Infektion bzw. eine Trisomie 13 mit multiplen Fehlbildungen nachgewiesen werden . 10/18 ( 55% ) Kinder mussten postpartal aufgrund des hypovolaemischen Schocks reanimiert werden , 15/18 Neugeborene wurden noch im Kreisssaal intubiert und maschinell beatmet . 7/18 ( 39% ) der Kinder ( 6 Frueh- und ein reifes Neugeborenes mit Trisomie 13 ) verstarben zwischen dem 1. und 6. Lebenstag . Fuenf der 7 Kinder mussten postnatal reanimiert werden . 6/18 ( 33% ) Kinder zeigten bei der Entlassung aus der Kinderklinik neurologische Auffaelligkeiten . Bei 5 der 6 neurologisch auffaelligen Kinder war postnatal eine Reanimation notwendig . 5/18 ( 28% Kinder ( ) 3 Reifgeborene ) entwickelten sich unauffaellig . Zusammenfassend kann festgestellt werden , dass eine konnatale Anaemie mit einem Haemoglobingehalt unter 10 g/dl zwar sehr selten ist , aber durch ihre schlechte Prognose erhebliche Bedeutung fuer die betroffenen Kinder hat . Es erscheint notwendig , die primaere Reanimation durch sofortige Blutgabe und Steuerung der Volumengabe ueber die Messung des zentralen Venendrucks mittels Nabelvenenkatheter zu optimieren , um so die Prognose guenstig zu beeinflussen ."
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PerinatalMedizin.60080093.ger.abstr | PerinatalMedizin.60080093.ger.abstr | [
{
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"Zusammenfassung . Wie bereits an ueber 44 Nabelschnurbluttransplantationen bei Geschwistern ( 34 HLA-identisch , 10 mit 1-3 HLA-Locus-Mismatchen ) und 6 unverwandten ( 1 HLA-identisch , 5 mit 1-3 HLA-Locus-Mismatchen ) Transplantationen gezeigt , ist das plazentare Restblut eine reiche Quelle haematopoetischer Stamm- und Vorlaeuferzellen . Aus diesem Grund wurde hier eine Pilotstudie gestartet , um aus plazentarem Restblut die Definition , Charakterisierung und Standardisierung fuer entsprechende Stammzelltransplantate erstellen zu koennen . Bisher wurden 372 Nabelschnurbluttransplantate ( Stand 10. 05. 1995 ) mit einer mittleren Volumenmenge von 78 +/- 32 ml und 8,4 +/- 5 - 108 Leukozyten fuer familiengerichtete Transplantate ( n=12) und als unverwandte Stammzellasservate ( n=360) abgenommen , charakterisiert und unsepariert in fluessigem Stickstoff gelagert . Die Abnahme des Plazentarestblutes ( PR ) erfolgte aus der Nabelschnurblutvene nach normalen Geburten ( n=302) oder nach einem Kaiserschnitt ( n=70). Sowohl fuer die serologische als auch fuer die molekulargenetische HLA-Klasse-I- und -II-Typisierung wurden Methoden entwickelt , die eine komplette HLA-Typisierung aus 1,5 ml PR ermoeglichen . Zusaetzlich werden nur 3,5 ml fuer die Kontrolle der Sterilitaet , fuer die Bestimmung der Vorlaeuferzellen ueber Koloniebildungstests und CD 34 sowie die Testung auf kontaminierende muetterliche Zellen mit Hilfe der simultanen immunphaenotypischen und genotypischen Analyse oder der PCR-SSP fuer das nicht vererbte HLA-Allel der Mutter benoetigt . Die Seren der Mutter werden auf Hepatitis B , A , C , HIV1, HIV2, EBV , VCA , HTLVI-II , CMV , Toxoplasmose und TPHA getestet ."
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] |
PerinatalMedizin.80100012.ger.abstr | PerinatalMedizin.80100012.ger.abstr | [
{
"id": "PerinatalMedizin.80100012.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Gegenstand : Im unteren Uterinsegment kommt es im Verlauf der Muttermundseroeffnung zu zytokinabhaengigen Veraenderungen ( z . B. Extravasation neutrophiler Granulozyten ) . Wir untersuchten daher die Konzentrationen von TNF , IL-1, IL-6 und IL-8 im unteren Uterinsegment in 4 verschiedenen Stadien der Muttermunderoeffnung am Termin . Zur Beantwortung der Frage , ob es zu aehnlichen Veraenderungen auch bei Geburtsbeginn vor Erreichen des Geburtstermins kommt , untersuchten wir die Konzentrationen dieser Zytokine bei der Fruehgeburt . Methode : Dazu wurde bei 35 Patientinnen mit Termingeburt und bei 33 Patientinnen mit Fruehgeburt , die per Sectio caesarea entbunden wurden , bei einer Muttermundweite ( MMW ) von 2 cm , 2 - 3 cm , 4 - 6 cm und > 6 cm eine Gewebeprobe aus dem unteren Uterinsegment entnommen . Die Zytokinkonzentrationen wurden im Proteinextrakt der Proben mit Hilfe von Enzymimmunoassays bestimmt . Ergebnisse : Bei der Termingeburt betrug der Median der Konzentration bei einer MMW 2 cm fuer TNF 7,9 pg/ml Gesamtprotein ( GP ) , fuer IL-1 1,3 pg/mg GP , fuer IL-6 12,6 pg/ml GP und fuer IL-8 17,2 pg/mg GP . Mit Ausnahme von TNF zeigten alle untersuchten Zytokine einen signifikanten Konzentrationsanstieg bis zu einer MMW von 4 - 6 cm , danach ein Plateau . Bei der Fruehgeburt betrug der Median der Konzentration bei einer MMW 2 cm fuer TNF 16,5 pg/mg GP , fuer IL-1 1,1 pg/mg GP , fuer IL-6 10,3 pg/mg GP und fuer IL-8 13,6 pg/mg GP . Die IL-1-, IL-6- und IL-8-Konzentrationen lagen bei einer MMW von 2 - 3 cm signifikant hoeher als bei einer MMW 2 cm . Schlussfolgerung : Bei der Termingeburt kommt es mit zunehmender Muttermunderoeffnung zu einem Anstieg der Konzentrationen bestimmter Zytokine ( IL-1, IL-6 und IL-8) im unteren Uterinsegment . Aehnliche Veraenderungen deuten sich auch bei der Fruehgeburt an ."
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PerinatalMedizin.80100016.ger.abstr | PerinatalMedizin.80100016.ger.abstr | [
{
"id": "PerinatalMedizin.80100016.ger.abstr-passage-0",
"type": "abstract",
"text": [
"In der vorliegenden Arbeit sollte die Bedeutung von Stickstoffmonoxid ( NO ) fuer den ischaemiebedingten neuronalen Zelltod beim Feten unabhaengig vom Herz-Kreislauf-System untersucht werden . Hierzu verwendeten wir ein hippokampales Gewebeschnittmodell . Als Marker fuer den neuronalen Zellschaden waehlten wir die postischaemische Beeintraechtigung des Energiestoffwechsels und der Proteinbiosynthese . Methode : Reife Meerschweinchenfeten wurden mit Halothan narkotisiert . Das Hippokampusareal des Gehirns wurde entnommen und in 500 µm dicke Scheiben geschnitten . Die Gewebescheiben wurden in artifizielle Liquorfluessigkeit ( aCSF ) transferiert und mit O2/CO2 ( 95%/5% ) in einer Inkubationskammer begast . Zur Induktion der Ischaemie in vitro wurden die Gewebescheiben in einen glukosefreien aCSF transferiert und fuer 10 - 40 min mit N2/CO2 ( 95%/5% ) begast . Bei einem Teil der Gewebeschnitte wurde die NO-Synthase mit 100 µM N-Nitro-L-Arginin ( NNLA ) geblockt . Die Aktivierung der NO-Synthase waehrend der Ischaemie wurde ueber die Gewebekonzentration von cGMP bestimmt . cGMP wurde mit einem Radioimmunoassay gemessen 12 ; h nach Ischaemie in vitro wurden die Adenylate und die Proteinbiosyntheses in den Gewebescheiben bestimmt . Die Konzentration der Adenylate wurde mit HPLC nach Extraktion mit Perchloressigsaeure gemessen . Die Proteinbiosynthese wurde als Inkorporationsrate von L- [ 1-14C] Leucin in Gewebeproteine ermittelt . Unterschiede innerhalb und zwischen den Gruppen wurden mit einer zweifaktoriellen Varianzanalyse und Scheffé-post-hoc-Test auf Signifikanz ( p 0.05 ) geprueft . Ergebnisse : Waehrend einer 40minuetigen Ischaemie in vitro stieg die Konzentration von cGMP in den Gewebescheiben signifikant an ( Kontrolle ; 1,35 +/- 0,38 pmol/mg Protein vs. I 40 : 18,6 +/- 1,04 pmol/mg Protein : p 0.05 ) . Der cGMP-Anstieg waehrend der Ischaemie konnte durch NNLA nahezu vollstaendig inhibiert werden . Allerdings gelang es nicht durch NNLA den Energiestoffwechsel oder die Proteinbiosynthese 12 h nach 40minue-tiger Ischaemie in vitro zu verbessern . Schlussfolgerung : Die NO-Synthase wird waehrend einer Ischaemie im fetalen Gehirn erheblich aktiviert . Stickstoffmonoxid scheint dabei unabhaengig von seinen Wirkungen auf das Herz-Kreislauf-System fuer die Genese des neuronalen Zelltodes nach einer transienten Ischaemie im unreifen Gehirn keine groessere Bedeutung zu haben ."
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PerinatalMedizin.80100020.ger.abstr | PerinatalMedizin.80100020.ger.abstr | [
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"text": [
"In der Behandlung des beatmungspflichtigen Atemnotsyndroms Fruehgeborener hat sich die Anwendung bovinen Surfactants etabliert [ 2 , 3 ] . In den ersten Jahren nach Einfuehrung verschiedener Praeparate wurde mehrheitlich die Bolusinjektion mittels markierter Magensonde ( pertubal intratracheal ) , empfohlen und praktiziert . Mit dieser Anwendungsform koennen sich jedoch auch mehrere Negativeffekte verbinden : ..."
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PerinatalMedizin.80100024.ger.abstr | PerinatalMedizin.80100024.ger.abstr | [
{
"id": "PerinatalMedizin.80100024.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Apnoen Bradykardien und Entsaettigungen , bei sehr kleinen Fruehgeborenen sind von grosser klinischer Bedeutung . In welcher Intensitaet und Haeufigkeit diese Ereignisse klinisch bedrohlich sind und wie zu therapieren ist , ist kontrovers . Das Ziel einer verkuerzten Beatmungsdauer zur Verhinderung von Traumatisierungen der Lunge bei sehr kleinen Fruehgeborenen macht alternative Behandlungsstrategien erforderlich . Wir haben in mehreren Studien die medikamentoese Beeinflussbarkeit dieser Ereignisse durch Teophyllin , Aminophyllin , Doxapram und nasalem CPAP untersucht . Aufgrund der Ergebnisse dieser Studien wurde ein Therapiealgorithmus entwickelt , der mit diesem Beitrag vorgestellt werden soll . In zwei sukzessiv durchgefuehrten klinisch-kontrollierten Studien konnten wir zunaechst feststellen , dass reines Theophyllin , i.v. appliziert , dem Aminophyllin gleichwertig ist . Bei besserem Nebenwirkungsprofil sollte dem Teophyllin mit Natriumacetat als Loesungsvermittler der Vorzug gegeben werden . In einer historischen Vergleichsuntersuchung konnten wir die Ueberlegenheit der intravenoesen Methylxanthin-Therapie gegenueber einer peroral durchgefuehrten belegen . Die Ereignisse Bradykardien Apnoen und Entsaettigungen , wurden jeweils in der Monitor-Trend-Analyse und unter steady-state-Bedingungen in einer Polysomnographie mit begleitender Verhaltensbeobachtung nach Prechtl evaluiert . In einer retrospektiven Analyse von ueber 100 sehr kleinen Fruehgeborenen konnten wir zudem eine Effizienz der Behandlung mit nasalem CPAP als 3. Therapiestufe belegen . Die Zahl an Bradykardien , Apnoen und Entsaettigungen , Atemfrequenz und Oxygenierung wurden verbessert . Doxapram war insofern der Theophyllin-Therapie ueberlegen , als in den ersten 3 Therapietagen weniger Apnoen in der Doxapram-therapierten Gruppen auftraten . Bei mehr als 2 Apnoen ueber 20 Sekunden Dauer , 4 Bradykardien unter 80/min und/oder 4 Entsaettigungen unter 80% innerhalb von 2 Stunden werden Kinder nach folgendem Algorithmus bei uns behandelt : Nach Ausschluss sekundaerer Apnoe zunaechst Therapie mit Theophyllin 5 mg/kg ueber 20 Minuten i.v. , gefolgt von 2x3 mg/kg als Kurzinfusion ueber 20 Minuten , Maximaleffekt erst nach 5 Tagen . Wenn schnellere Wirkung gewollt , 1 mg/kg/h Doxapram als Dauerinfusion . Hat diese Therapie mit Theophyllin bzw. mit Doxapram mit 48 Stunden keinen Erfolg gezeitigt d . , h . nach wie vor als 3 Apnoen ueber 20 Sekunden in 48 Stunden oder 15 Bradykardien und Entsaettigungen in 48 Stunden wird das jeweils andere Medikament zusaetzlich eingesetzt . Ist weiterhin kein therapeutischer Erfolg nach den o.g. Kriterien zu verzeichnen , wird nasaler CPAP als Therapie eingesetzt . Erst danach ist u.U. eine Indikation zur maschinellen Beatmung gegeben . Mit diesem Therapiealgorithmus konnten wir eine Reduktion der Beatmungszeit sehr kleiner Fruehgeborener von 4,9 auf 3,4 Tage erreichen . Eine Evaluation entsprechender Therapiealgorithmen in multiinstitutionellen Untersuchungen ist angezeigt ."
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PerinatalMedizin.80100045.ger.abstr | PerinatalMedizin.80100045.ger.abstr | [
{
"id": "PerinatalMedizin.80100045.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Aus den Daten des Magdeburger Fehlbildungsregisters werden Basispraevalenzen von Indikatorfehlbildungen vorgestellt . Praevalenzen der Neuralrohrdefekte , der angeborenen Herzfehler , der Lippen-Kiefer-Gaumenspalten , des Down-Syndroms und der Omphalozele werden in ihren zeitlichen Haeufigkeiten beschrieben und moegliche Beziehungen zum Tschernobyl-Unglueck hergestellt . Die Fehlbildungserfassung erlaubt darueber hinaus Analysen zur Organbetroffenheit , der fehlbildungsbedingten Saeuglingssterblichkeit und zum Wirksamwerden der praenatalen Diagnostik ."
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"Basispraevalenzen"
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"Analysen"
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PerinatalMedizin.80100056.ger.abstr | PerinatalMedizin.80100056.ger.abstr | [
{
"id": "PerinatalMedizin.80100056.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Die Funktion der Cervix uteri waehrend der Schwangerschaft ist biochemisch durch eine ansteigende Synthese von Proteinen ( z.B. Kollagen ) , Proteoglykanen und Glykoproteinen ( z.B. Fibro-nektin ) sowie durch ein definiertes Zusammenwirken dieser Komponenten der extrazellulaeren Ma-trix charakterisiert . Im Gegensatz zur langsamen Reifungsphase der Zervix im letzten Schwangerschaftsdrittel ist die Muttermund-eroeffnung unter der Geburt durch eine rasche Synthese und Wirkung kataboler Enzymsysteme gekennzeichnet , in deren Folge es zum Kollagenabbau und zu Veraenderungen in der Kollagenstruktur sowie zum Abbau anderer Strukturproteine der Matrix kommt . Es bestehen Hinweise dafuer , dass ansteigende Konzentrationen von proinflammatorischen Zytokinen ( z.B. Tumornekrosefaktor und Interleukin-1 [ IL-1]) im unteren Uterinsegment zu einer zunehmenden Expression von Adhae-sionsmolekuelen durch das Kapillarendothel mit nachfolgender Extravasation neutrophiler Granulozyten in das Stroma fuehren . Die Chemotaxis und Degranulation dieser Zellen im Stroma koennte durch die parallel ansteigende Konzentration von IL-8 stimuliert werden . Die durch die Degranulation der neutrophilen Granulozyten freigesetzten Proteasen ( z.B. Matrixmetalloproteinase-8) treffen auf ein kollagenes Faserwerk , das bereits durch ein veraendertes Proteoglykanmuster ( z.B. Decorinverlust ) destabilisiert ist . Die Bedeutung dieser Erkenntnisse fuer die Klinik koennte in der Entwicklung neuer Konzepte fuer eine mehr kausal orientierte Therapie pathologischer Veraenderungen der Zervix waehrend der Schwangerschaft und unter der Geburt liegen ( z.B. Zervixinsuffizienz Zervixdystokie ) . ,"
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{
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{
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PerinatalMedizin.80100060.ger.abstr | PerinatalMedizin.80100060.ger.abstr | [
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"Auch das gesunde Neugeborene hat Anspruch auf eine optimale Betreuung , damit jede Stoerung der postnatalen Adaptation rechtzeitig erkannt wird . Die Einfuehrung schmerzloser einfacher und dennoch zuverlaessiger Methoden wie der Pulsoxymetrie und des transkutanen Bilirubinscreenings hat die Situation fuer alle verantwortlichen Personen erheblich vereinfacht ."
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PerinatalMedizin.80100063.ger.abstr | PerinatalMedizin.80100063.ger.abstr | [
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"Die tierexperimentellen und kli-nischen Beobachtungen belegen , dass bei geschaedigten Lungen unter Liquidventilation mit Perfluorcarbonen eine eindeutige Verbesserung des Gaswechsels und der Atemmechanik eintritt . Die bis-herigen Toxizitaetsuntersuchungen liefern keine eindeutigen Aussagen , die den weiteren Einsatz verbieten , jedoch ist der Katalog unbeantworteter Fragen noch zu lang , um einen klinischen Einsatz ( Stufe III ) heute schon vertreten zu koennen . Das moegliche Einsatzspektrum der Liquidventilation naehrt Hoffnungen , zukuenftig einen Teil offener therapeutischer und diagnostischer Probleme loesen zu koennen . Die Frage \" Liquidventilation - nur eine faszinierende neue Methode oder eine serioese therapeutische Alternative \" kann man aufgrund der vorliegenden Ergebnisse nicht endgueltig beantworten , aber die Daten berechtigen zur weiteren Pruefung der Methode als serioese alternative Beatmungsform ."
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PerinatalMedizin.80100081.ger.abstr | PerinatalMedizin.80100081.ger.abstr | [
{
"id": "PerinatalMedizin.80100081.ger.abstr-passage-0",
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"text": [
"Im Rahmen einer prospektiven randomisierten Multicenterstudie wurde bei 796 Patientinnen die Effizienz der Geburtseinleitung mittels 2 mg PGE2-Vaginalgel vs. 0,5 mg Intrazervikalgel bei unreifer Zervix ( Bishop-Score 3-4 ) und von 2 mg PGE2-Vaginalgel vs. der 3 mg PGE2-Vaginaltablette bei reifer Zervix ( Bishop-Score 5-7 ) vergleichend untersucht . Bei unreifen Muttermundsverhaeltnissen wies das 2 mg PGE2-Vaginalgel hinsichtlich des Reifungseffekts , der medianen Induktionsgeburtsintervalle und der kumulativen Entbindungsraten/24 h signifikant bessere Ergebnisse auf als das Intrazervikalgel ; keine signifikanten Unterschiede ergaben sich in der Haeufigkeit uteriner Ueberstimulierungen , unerwuenschter maternaler Begleitwirkungen , der Sectiorate und im fetal outcome \" . \" Bei reifer Zervix erwiesen sich das 2 mg PGE2-Vaginalgel und die 3 mg PGE2-Vaginaltablette als aequieffektiv . Mit dem 2 mg PGE2-Vaginalgel steht eine effiziente Applikationsform fuer die Geburtseinleitung ab einem Bishop-Score > =3 zur Verfuegung ."
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PerinatalMedizin.80100084.ger.abstr | PerinatalMedizin.80100084.ger.abstr | [
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"id": "PerinatalMedizin.80100084.ger.abstr-passage-0",
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"text": [
"Die Sammlung von gespendeter Frauenmilch hat in Deutschland eine lange Tradition . Mit modernen Screeningmethoden wird die Uebertragung von Infektionen ausgeschlossen . Es wird pasteurisierte und tiefgefrorene Spenderinnenmilch an andere Kliniken abgegeben . Die Inzidenz der nekrotisierenden Enterokolitis ist niedrig . Wegen ihrer guenstigen Zusammensetzung wird fuer sehr unreife Fruehgeborene die Milch von Spenderinnen bevorzugt , die selbst zu frueh geborene Kinder haben ."
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PerinatalMedizin.80100088.ger.abstr | PerinatalMedizin.80100088.ger.abstr | [
{
"id": "PerinatalMedizin.80100088.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Die Trisomie 5p zaehlt zu den seltenen Chromosomenanomalien . Ursaechlich fuer das Entstehen ist eine Translokation zwischen dem Chromosom 5 und 15 anzusehen . Nach Literaturangaben liegt in ca. 10% der Faelle eine balancierte Chromosomentranslokation eines Elternteils vor . Im vorliegenden Fallbericht werden die praenatale Diagnosestellung , ultrasonographische Befunde , der klinische Verlauf sowie pathologisch-anatomische Merkmale dieses Fehlbildungssyndroms dargestellt ."
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PerinatalMedizin.80100093.ger.abstr | PerinatalMedizin.80100093.ger.abstr | [
{
"id": "PerinatalMedizin.80100093.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Fetale Teratome sind extra- oder intrakorporale , durch Stoerung der Entwicklung entstandene Fehlbildungen unterschiedlicher Lokalisation . Obwohl relativ selten , koennen sie schwere geburtshilfliche Komplikationen verursachen , besonders wenn sie nicht praenatal diagnostiziert werden . Sobald Teratome sonographisch erfasst sind , wird eine prognostische Bewertung der Schwangerschaftsentwicklung und des , fetal outcome` notwendig . Beurteilungskriterien fetaler Teratome ergeben sich aus ihrer Lokalisation , ihrer Groesse und Binnenstruktur . Die sonographische Diagnostik kann Kriterien fuer ein konservatives oder invasives Vorgehen , Gruende fuer oder gegen eine Schwangerschaftsfortsetzung liefern . Sie stellt die praenatale Diagnosemassnahme dar mit der Moeglichkeit zur Reduzierung perinataler Morbiditaet und Mortalitaet , wie es an 8 praenatal untersuchten fetalen Teratomen in dieser Studie aufgezeigt wird ."
],
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PerinatalMedizin.90100105.ger.abstr | PerinatalMedizin.90100105.ger.abstr | [
{
"id": "PerinatalMedizin.90100105.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Die bronchopulmonale Dysplasie wurde erstmals von Northway und Mitarbeitern 1967 beschrieben . Seitdem konnte durch Fortschritte in der neonatalen Intensivtherapie das Ueberleben fruehgeborener Kinder deutlich verbessert werden . Die bronchopulmonale Dysplasie stellt jedoch weiterhin ein klinisches Problem dar , das mit einer hohen Mortalitaet und Morbiditaet verbunden ist . Die Datenlage hinsichtlich praeventiver und therapeutischer Massnahmen ist teilweise widerspruechlich . Fuer den neonatologisch Taetigen ist ein aktueller Ueberblick darueber unabdingbar , um fuer die Kinder mit bronchopulmonaler Dysplasie die geeignete Therapie auszuwaehlen ."
],
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PerinatalMedizin.90100109.ger.abstr | PerinatalMedizin.90100109.ger.abstr | [
{
"id": "PerinatalMedizin.90100109.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Die erste Lebenszeit hat einen besonderen Einfluss auf die Haeufigkeit und Dauer des Stillens . Wenn man das Stillen als einzig optimale und adaequate Ernaehrung fuer den menschlichen Saeugling anerkennt , sollte alles getan werden um optimale Bedingungen fuer das Stillen zu schaffen . Es werden verschiedene Punkte diskutiert , bei denen Verbesserungen im Sinne des Stillens moeglich waeren und solche , bei denen sich traditionelle Gesichtspunkte , z.T. noch aus der Zeit ueberwiegend kuenstlicher Ernaehrung , in der Praxis halten . Zu diesen und zu anderen werden Loesungsvorschlaege nach modernen Gesichtspunkten angeboten ."
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"Zusammenfassung Ein Ueberblick zur Forschungsliteratur zur muetterlichen Gesundheit zeigt , dass die Zahl empirischer Untersuchungen in den vergangenen Jahren im deutsch- und englischsprachigen Raum zwar zugenommen hat , der aktuelle Stand der Forschung jedoch nicht befriedigend ist . In der Literatur werden Studien beschrieben , die Zusammenhaenge zwischen der Gesundheit von Muettern bzw. Frauen und ihren sozialen , familiaeren und beruflichen Situationen untersuchen . Dabei wird der psychodynamische Hintergrund psychosomatischer Erkrankungen von Muettern so gut wie nicht erfasst . Eigene klinische Erfahrungen weisen jedoch darauf hin , dass psychodynamische Zusammenhaenge bei den Ursachen psychosomatischer Erkrankungen von Muettern bedeutsam sind . So ist der Kinderwunsch fuer einige Muetter der Versuch , schon vor der Schwangerschaft bestehende aktuelle Konflikte zu kompensieren . Bei anderen Muettern werden seit der Kindheit ungeloeste neurotische Konflikte aus der Beziehung zu den eigenen Eltern aktualisiert , die von den Patientinnen nicht bewaeltigt werden koennen . In der Versorgung dieser Klientel bestehen erhebliche Defizite . Ambulante Therapien scheitern bei vielen Muettern an der fehlenden Kinderbetreuung , und eine stationaere psychosomatische Behandlung der Muetter zusammen mit ihren Kindern ist nur selten moeglich . Ambulante psychotherapeutische Behandlungskonzepte , die eine stationaere Behandlung ersetzen koennten , gibt es weder national noch international ."
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Psychotherapeut.00450018.ger.abstr | Psychotherapeut.00450018.ger.abstr | [
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"Zusammenfassung Die Saeuglings- und Kleinkindforschung lieferte in den letzten beiden Dekaden empirisch begruendete Ergebnisse , die eine mangelnde psychophysische Belastbarkeit im spaeteren Leben und eine Anfaelligkeit fuer psychosomatische Symptome erklaeren koennen . Interaktionsprozesse und der affektive Austausch zwischen Bezugsperson und Kind ermoeglichen in den ersten Lebensmonaten die Grundregulation und fuehren zu Repraesentanzen von Interaktionen , die die Basis fuer die spaetere Bindungsqualitaet des Kindes bilden . Diese mutuelle Regulation des Mutter-Kind-Paares bildet die Grundlage fuer die selbstregulativen Faehigkeiten des spaeteren Erwachsenen , der in unterschiedlichem Ausmass auf verschiedenen Ebenen sprachlich-symbolisch oder koerperlich-psychosomatisch auf Disstress reagiert . Erste Erfahrungen mit der Umsetzung dieser Vorstellungen auf die Behandlung psychosomatisch Erkrankter werden vorgestellt ."
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"Zusammenfassung Suchterkrankungen sind nicht zwangslaeufig auf eine strukturelle ( fruehe ) Persoenlichkeitsstoerung zurueckzufuehren , auch wenn bei manifest Suchtkranken fruehe Mechanismen klinisch zu beobachten sind . Die Entstehung ist in einem weiteren Kontext zu sehen : Sie haengt ab von der \" positiven \" Wirkung des Suchtmittels im Sinne von Wunscherfuellung und Entspannung sowie von gesellschaftlich akzeptierten Einstellungen zum Gebrauch von Suchtmitteln , z.B. in legitimen \" Ritualen \" des Konsums ( z.B. Trinksitten ) , in denen , bei leichter Verfuegbarkeit von Suchtmitteln , durch das haeufige Herbeifuehren von Rauschzustaenden regressive Veraenderungen der Persoenlichkeitsstruktur erfolgen . Stossen Menschen durch die Regression unter Alkohol auf Erfahrungen von Unlust und Spannung , so schraenken sie ihren Alkoholkonsum ein ."
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"Zusammenfassung Die klinisch-psychotherapeutische Behandlung Psychosekranker ist entwicklungsgeschichtlich in der Psychoanalyse verwurzelt und hat ebenso wie diese einen Veraenderungsprozess durchlaufen . Nachdem die analytische Psychosenpsychotherapie bis Mitte der 50er Jahre insbesondere in England und den USA dominiert hatte , verlor sie mit dem Aufkommen der modernen Psychopharmakotherapie und Sozialpsychiatrie stark an Bedeutung . In den 80er Jahren zeigten grosse Verlaufsstudien die Ueberlegenheit von kognitiven und verhaltensorientierten Therapiekonzepten . Das Interesse gerade der klinisch taetigen Psychiater an einer Psychotherapie , die die individuelle Beziehung zwischen Arzt bzw. Behandlungsteam und Patient im Vordergrund sieht , besteht jedoch weiterhin . Ergebnisse der Saeuglingsforschung haben in der letzten Zeit der analytischen Psychosentherapie neue Impulse gegeben . Dieser Entwicklungsprozess soll im Folgenden nachgezeichnet werden ."
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Psychotherapeut.00450044.ger.abstr | Psychotherapeut.00450044.ger.abstr | [
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"text": [
"Zusammenfassung 13 erfahrene Suchttherapeutinnen und -therapeuten machten Angaben zu Traumaerfahrungen und Komorbiditaet fuer 122 Klientinnen und Klienten ( 26 Frauen , 96 Maenner ) mit Opiatabhaengigkeit und multiplem Substanzmissbrauch . Bei 42% wurde mindestens eine traumatische Lebenserfahrung aufgeklaert , bei Frauen signifikant haeufiger als bei Maennern . Die Viktimisierung geschah ueberwiegend im Kindesalter , vor Beginn des Drogenkonsums . Bei 26% der Traumatisierten wurde eine Posttraumatische Belastungsstoerung festgesellt . Im Vergleich zu Personen ohne Traumaerfahrung wurden bei Viktimisierten signifikant mehr komorbide Symptome beobachtet sowie haeufiger Polytoxikomanie und Erfahrung mit Psychotherapie ."
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Psychotherapeut.00450063.ger.abstr | Psychotherapeut.00450063.ger.abstr | [
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"Substanzabhaengige sind eine der groessten Patientengruppen , die mit gutem Erfolg psychotherapeutisch behandelbar sind . Dennoch waren sie lange nicht nur \" ungeliebte Kinder der Psychiatrie \" , sondern auch der Psychotherapie . Im ersten Teil dieser Uebersicht werden moegliche Bedenken hinsichtlich der Psychotherapie dieser Patienten diskutiert : Mangelnde Ausbildung , Versorgungsstrukturen , eine mutmassliche Unzuverlaessigkeit der Suchtkranken , befuerchtete Misserfolge und eine Tabuisierung dieser Stoerungen unter Psychotherapeuten sind durchaus ernstzunehmende Argumente , Suchtkranke nicht zu behandeln . Es wird aber auch deutlich gemacht , dass diese Hinderungsgruende ueberwunden werden koennen . Es ist lohnend , sich diesen Patienten zuzuwenden , auch wenn die psychotherapeutische Arbeit mit Substanzabhaengigen zumindest phasenweise anstrengend sein kann . Da sich Suchtkranke oft mit anderen Beschwerden vorstellen , ist es wichtig , die Substanzproblematik fruehzeitig festzustellen . Die deskriptive Diagnostik basiert auf einer Differenzierung der Konsumfolgeschaeden von dem Abhaengigkeits- oder Missbrauchssyndrom . Bei Substanzabhaengigen sind Aenderungsbereitschaft und Therapiemotivation nicht Voraussetzung sondern Gegenstand , der Psychotherapie . Die Motivationstherapie \" \" basiert auf einer empathischen , aber reflektiert-klaren therapeutischen Haltung . Der erste Teil dieser Uebersicht schliesst mit der Beschreibung derartiger Interventionen und einer Skizze stationaerer und ambulanter Settings . Im folgenden zweiten Teil werden spezifische Beitraege verschiedener Psychotherapieansaetze vorgestellt ."
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Psychotherapeut.00450072.ger.abstr | Psychotherapeut.00450072.ger.abstr | [
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"text": [
"Untersucht wird der Zusammenhang von beruflichen Veraenderungen , Belastungen , und psychosomatischen Beschwerden bei Patienten in der zweiten Haelfte des Berufslebens . In der Katamnesestudie wurden alle Patienten der Psychosomatischen Klinik Bad Neustadt/Saale ( Rehabilitation ) von August 1996 bis Februar 1997 bei Aufnahme und Entlassung untersucht . 158 aeltere Patienten ( 50-59 Jahre ) wurden mit 30-39jaehrigen ( n=97) und 40-49jaehrigen ( n=157) Patienten mit standardisierten und eigens entwickelten Messverfahren fuer psychosomatische Beschwerden und berufliche Belastung verglichen . Aeltere Patienten waren bei Aufnahme psychisch weniger belastet als die juengeren und aeusserten eine insgesamt hoehere Lebenszufriedenheit . Sie gaben groessere Veraenderungen und Unzufriedenheit im beruflichen Bereich an , sahen diesbezueglich geringere Einflussmoeglichkeiten und waren bzgl. ihrer weiteren Taetigkeit pessimistischer . Aeltere Patienten erlebten v.a. die Einfuehrung neuer Technologien ( EDV ) und den Wechsel des Vorgesetzten bedrohlicher als die anderen Altersgruppen und reagierten mit einer negativeren Arbeitseinstellung und erhoehter Anspannung . Eine therapeutische Aufarbeitung - unter Beruecksichtigung der Geschlechtsunterschiede - ist dringend erforderlich ; exemplarisch werden Strategien zum Abbau von computerbezogenen Aengsten diskutiert ."
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Psychotherapeut.00450082.ger.abstr | Psychotherapeut.00450082.ger.abstr | [
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"In dieser Arbeit werden die konzeptuellen Ueberlegungen bei der Planung einer stationaeren Behandlungseinheit fuer Patientinnen und Patienten mit Realtraumatisierung und deren Umsetzung beschrieben . Die unterschiedlichen Modellvorstellungen zur Traumadynamik und Aetiopathologie des posttraumatischen Stresssyndroms ( PTSD ) wirken sich strukturgebend auf die Realisierung sehr differenter Konzepte stationaerer Traumatherapie aus . Der Einsatz von Konzentrativer Bewegungstherapie ( KBT ) und Gestaltungstherapie in unserem konflikt- und loesungsorientierten analytischen Konzept laesst den scheinbaren Widerspruch von Traumaexposition und Traumalimitation in den Hintergrund treten und eroeffnet einen Uebergangsraum \" ( \" Winnicott ) kreativer Arbeit mit den Patienten . Die Anwendung der KBT bei der Ueberfuehrung der traumatischen Koerpererinnerungen mittels Symbolisierungsarbeit im vorsprachlichen Bereich hin zu einem narrativen Erinnerungsskript wird an Fallbeispielen illustriert ."
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Psychotherapeut.00450090.ger.abstr | Psychotherapeut.00450090.ger.abstr | [
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"text": [
"Der Autor gibt einen kurzen Ueberblick ueber die psychodynamischen und psychoanalytischen Grundlagen der Katathym-imaginativen Psychotherapie ( KiP ) . Die Unterschiede der Imaginationen von neurotischen und ich-strukturell gestoerten Patienten werden demonstriert und diskutiert . Zur Illustration werden ausfuehrlich zwei klinische Faelle beschrieben , welche die Besonderheiten der Symbolbildung auf den verschiedenen ich-strukturellen Niveaus zeigen . Dann werden die wichtigsten Befunde der neueren Kleinkindforschung und der Bindungsforschung , speziell die Ergebnisse der Gruppe von Fonagy , in ihrer Bedeutung fuer die Symbolbildung diskutiert . Das Konzept des potentiellen Raums wird als Basis fuer das Verstaendnis imaginativer Prozesse verwendet . Allgemeine und spezielle technische Empfehlungen fuer die Behandlung von Borderlinestoerungen mit der KiP werden daraus abgeleitet . Der Bezug zu den Theorien von Bion , Ogden und Winnicott wird dabei besonders gewuerdigt ."
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Psychotherapeut.00450108.ger.abstr | Psychotherapeut.00450108.ger.abstr | [
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"Die vorliegende Arbeit hat das Ziel , Unterschiede in der Wahrnehmung des Patienten bei der psychotherapeutischen Erstuntersuchung je nach theoretischer Orientierung des Diagnostikers zu untersuchen . Sie basiert auf den Einschaetzungen von neun tiefenpsychologisch/analytisch und vier kognitiv-verhaltenstherapeutisch orientierten Therapeuten , die 144 bzw. 89 Patienten einer universitaeren psychotherapeutischen Poliklinik nach dem Erstgespraech beurteilten . Kognitiv-verhaltenstherapeutisch orientierte Erstuntersucher nahmen die Qualitaet der therapeutischen Arbeitsbeziehung signifikant als besser und die Patienten , die sie untersuchten , als sympathischer wahr . Tiefenpsychologisch orientierte Diagnostiker sahen staerker ausgepraegte fruehkindliche Belastungen , wohingegen Verhaltenstherapeuten die aktuelle Bewaeltigungskompetenz der Patienten hoeher bewerteten . Zudem schaetzen sie die Motivation des Patienten , das gemeinsame Krankheitsverstaendnis , verschiedene prognostische Faktoren sowie die globale Prognose als guenstiger ein . Hinsichtlich der Haeufigkeit diagnostischer Kategorien und der Beurteilung der Beeintraechtigungsschwere fanden sich keine Unterschiede je nach therapeutischer Orientierung . Die festgestellten Unterschiede werden sowohl vor einem kognitiv-verhaltenstherapeutischen als auch vor einem psychoanalytischen Theoriehintergrund interpretiert ."
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Psychotherapeut.00450153.ger.abstr | Psychotherapeut.00450153.ger.abstr | [
{
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"In der vorliegenden Untersuchung wurden 766 Personen im Alter zwischen 61 und 92 Jahren mit der deutschsprachigen Kurzfassung ( 64 Items ) des Inventars \" zur Erfassung interpersonaler Probleme \" ( IIP-C ; Horowitz et al. 1994 ) befragt . Die Itemanalyse zum IIP-C bei Aelteren erbrachte zufriedenstellende testtheoretische Kennwerte , die das Verfahren auch fuer das hoehere Lebensalter als geeignet erscheinen lassen . Bei der Interpretation der Testwerte spielt das Lebensalter jenseits des 6. Lebensjahrzehnts offensichtlich keine bedeutende Rolle mehr , ebenso wenig das Geschlecht . Von Bedeutung sind dagegen Ost-West-Unterschiede in interpersonalen Bezuegen . Die Ergebnisse lassen die Aelteren in Ostdeutschland in ihren interpersonalen Bezuegen als offener , eher Naehe suchend und sozial kompetenter erscheinen . Da die hier beschriebenen Daten zum IIP-C aus einer zufaellig gezogenen Normalstichprobe stammen , koennen sie als weitgehend repraesentativ fuer die ueber 60jaehrige Bevoelkerung gelten . Sie koennen somit als geeignete Vergleichswerte herangezogen werden , um in aelteren Patientengruppen auffaellige interpersonale Probleme identifizieren zu koennen ."
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Psychotherapeut.00450165.ger.abstr | Psychotherapeut.00450165.ger.abstr | [
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"Bislang wurde die Indikationsfrage fuer psychoanalytische Gruppenpsychotherapie nur unzureichend geklaert . In diesem Beitrag wird unter der Praemisse , dass die psychoanalytische Gruppentherapie ein eigenstaendiges Verfahren darstellt , die Frage untersucht , welche Patienten optimalerweise von der Gruppenmethode profitieren koennten . Es wird die These vertreten , dass der Gruppenprozess selbst eine Reihe von therapeutischen Wirkfaktoren entfaltet , die von der psychoanalytischen Einzeltherapie nicht bereitgestellt werden koennen . Zunaechst werden eine Reihe diagnostischer struktureller , motivationaler und kognitiver Indikationskriterien , diskutiert , bevor die Momente der Kohaesionsfaehigkeit und von Aspekten sozialer Bezogenheit als Indikationshilfen in das Zentrum der Ueberlegungen gerueckt werden . Da nach bislang vorliegenden Ergebnissen der Outcomeforschung in der Gruppenpsychotherapie die Kohaesion als das Pendant der hilfreichen Beziehung angesehen werden muss , ist in diesem Verfahren die Frage nach der Indikationsstellung neben dem Setting unabdingbar mit der Gruppenzusammenstellung verbunden . Es wird resuemiert , dass psychoanalytische Gruppenpsychotherapie gerade fuer solche Patienten indiziert waere , bei denen entwicklungsbedingte Einschraenkungen der emotionalen Kompetenz verbessert werden sollen ."
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"Niklas Luhmann stellte 1984 mit seinem Werk \" Soziale Systeme \" ein Theoriegebaeude vor , das zur Beschreibung sozialer psychischer und biologischer Systeme , geeignet ist . Er betont dabei einerseits die selbstreferentielle Geschlossenheit der drei Systemebenen Kommunikation ( Soziales Bewusstsein ( ) , Psyche ) und Leben ( Biologie Physiologie ) , , anderseits liefert er ein Modell , wie diese Systemebenen trotz voelliger funktioneller Trennung miteinander verknuepft sind und einander gegenseitig bedingen . Im Rahmen dieser Theorie kann Psychotherapie als soziales System aufgefasst werden , das von Patient und Therapeut erzeugt wird und den Resonanzraum fuer eine psychische Veraenderung oder Entwicklung zur Verfuegung stellt . Diese Betrachtungsweise ermoeglicht einen neuen Blick auf das , was in einer Psychotherapie geschieht und was darueber prinzipiell ( nicht ) gewusst und verstanden werden kann ."
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Psychotherapeut.00450176.ger.abstr | Psychotherapeut.00450176.ger.abstr | [
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"Auf dem Hintergrund kurzer Beschreibungen psychodynamisch orientierter stationaerer Psychotherapie und eines kognitiv-verhaltenstherapeutischen Rollenspielansatzes zur Verbesserung sozialer Kompetenz wird die Evaluation einer zeitlich befristeten Kombinationsbehandlung , in deren Rahmen beide Ansaetze angeboten wurden , dargestellt . Die Ergebnisse zeigen , dass besonders bei Patientinnen und Patienten mit einem hohen Grad an sozialer Angst oder der Diagnose einer sozialen Phobie eine deutliche Verbesserung auf Massen der sozialphobischen Symptomatik feststellbar ist . Probleme , die sich aus der Anwendung von kognitiv- behavioralen Therapieelementen in einem grundsaetzlich psychodynamisch orientierten Setting ergeben , werden ebenso diskutiert wie die Erhoehung der Akzeptanz dieser Kombination im therapeutischen Team ."
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Psychotherapeut.00450203.ger.abstr | Psychotherapeut.00450203.ger.abstr | [
{
"id": "Psychotherapeut.00450203.ger.abstr-passage-0",
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"Ein Grossteil der ambulanten Psychotherapien ist von kurzer Dauer . Dennoch werden neuere psychodynamische Kurztherapien in Ausbildung und Praxis wenig rezipiert . Beschrieben wird die Entwicklung von triebdynamischen zu interpersonellen und eklektischen Ansaetzen . Die Besonderheiten der Behandlungstechnik hinsichtlich der Zeit und der Ziele , die Notwendigkeit groesserer Aktivitaet der Therapeuten sowie der fruehzeitigen Festlegung auf und Orientierung an einem Behandlungsfokus werden dargestellt . Es folgt eine Diskussion der Kontroversen im Umgang mit Uebertragung und Widerstand an Hand neuerer Forschungsergebnisse . Gute und anhaltende Effekte der zunehmend manualisierten Behandlungen sind fuer weniger schwere Erkrankungen ( z . B. akute Anpassungsstoerungen ) gesichert . Mit der Ausweitung des Indikationsbereichs erscheint es sinnvoll , nicht an starr und eng gesteckten zeitlichen Grenzen festzuhalten , und es werden behandlungstechnische Veraenderungen erforderlich . Forschungsbedarf besteht weiterhin zur Indikation , zum Stellenwert von Kurzzeitbehandlungen im Verlauf der Behandlungskarriere und zu geeigneten Formen der Ausbildung ."
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Psychotherapeut.00450214.ger.abstr | Psychotherapeut.00450214.ger.abstr | [
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"In der Psychiatrischen Universitaetsklinik von Turku wurde in den letzten Jahrzehnten ein umfassendes , auf die Beduerfnisse des Einzelnen zugeschnittenes , psychotherapeutisches Behandlungsverfahren fuer ersterkrankte Schizophrene entwickelt . In Verbindung mit Multizenterstudien wurde untersucht , ob das Modell fuer staatliche Gesundheitssysteme geeignet ist . In zahlreichen Zentren in Finnland , aber auch in anderen skandinavischen Laendern wurde es erprobt . Die Etablierung von alle Beteiligten in Verbindung bringenden Treffen zu Beginn der Behandlung ( therapeutische Meetings ) , denen sowohl das Team der Behandler als auch der Patient und seine Familie beiwohnen , erwies sich einerseits als therapeutisch bedeutsam und andererseits als wichtig zur Einschaetzung der therapeutischen Erfordernisse im speziellen Fall . Die sehr positiven Erfahrungen mit diesem Behandlungsmodell und die Nachuntersuchungsergebnisse werden beschrieben . Auf Indikation und Prinzipien der psychoanalytisch orientierten Einzelpsychotherapie mit schizophrenen Patienten wird besonders eingegangen ."
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Psychotherapeut.00450223.ger.abstr | Psychotherapeut.00450223.ger.abstr | [
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"In einer prospektiven naturalistischen klinischen Studie wurde bei 65 Patienten1 ( Wir verwenden im folgenden den Begriff \" Patienten \" und schliessen die weiblichen Patienten mit ein . ) mit verschiedenen psychosomatischen Stoerungen untersucht , in wie weit der Erfolg einer stationaeren Psychotherapie ( mittlere Dauer 7 Wochen ) aus einer eingangs bestimmten Bindungsqualitaet ( Erwachsenen-Bindungsprototypen-Rating - EBPR - nach Strauss und Lobo-Drost ) und aus den interpersonalen Problemen ( IIP nach Horowitz et al. ) vorhergesagt werden kann . Das Ausmass , mit dem das individuelle Therapieziel ( GAS ) erreicht wurde , konnte ( schwach aber signifikant ) aus der Bindungssicherheit , , nicht hingegen aus den Bindungsprototypen vorhergesagt werden . Der Therapieabbruch als weitere Outcomevariable korrelierte ebenfalls nur schwach , aber signifikant mit einer Skala des IIP ( Dominanz ) ."
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Psychotherapeut.00450230.ger.abstr | Psychotherapeut.00450230.ger.abstr | [
{
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"Die vorliegende Arbeit berichtet ueber eine retrospektive Untersuchung zur Erfassung der Wirksamkeit sowie der Stabilitaet des Therapieerfolgs bioenergetischer Einzeltherapien von Erwachsenen in Privatpraxen . Im Fruehjahr 1997 wurden mittels eines Fragebogens von 16 Bioenergetikern und Bioenergetikerinnen1 ( Zugunsten der Lesefreundlichkeit werden zukuenftig geschlechtsneutrale Formulierungen verwendet ) ( 6 Mediziner , 10 Psychologen ) der Schweizerischen Gesellschaft fuer Bioenergetische Analyse und Therapie ( SGBAT Daten ) ueber insgesamt 319 Patienten zusammengetragen , deren abgeschlossene Therapien von mindestens 20 Sitzungen wenigstens 6 Monate und laengstens 6 Jahre zuruecklagen . Es wurde ein Fragebogen konstruiert und an die 319 ehemaligen Patienten verschickt . Dieser anonym zu beantwortende Fragebogen enthaelt Fragen zum psychischen und koerperlichen Befinden , zu interpersonellen und psychosomatischen Problemen sowie zur Auswirkung von Koerperarbeit auf Koerperbewusstsein , Einsichten und Lebensqualitaet . Von den 319 angeschriebenen Patienten konnten 290 postalisch erreicht werden ; 142 ( 49% ) sandten den Fragebogen zurueck . Die statistische Auswertung der Daten zeigte , dass die Therapie zu signifikanten positiven Veraenderungen in allen Bereichen fuehrte , wobei die Koerperarbeit selbst bei ca. der Haelfte der Patienten als ausschlaggebend eingeschaetzt wurde . Das erzielte Therapieergebnis war bei 107 Patienten ueber die Zeit der Beendigung der Therapie hinaus bis zum Zeitpunkt der Befragung , also ueber ein halbes bis 6 Jahre , stabil geblieben oder hat sich gar verbessert . Von den 35 PatientInnnen , welche nach Beendigung der bioenergetischen Therapie eine weitere Therapie aufsuchten , waehlten 16 nochmals eine koerperorientierte Psychotherapie ."
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Psychotherapeut.00450286.ger.abstr | Psychotherapeut.00450286.ger.abstr | [
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"46 Psychotherapieabbrecher sind 599 Vollendern gegenuebergestellt und hinsichtlich auffaelliger Persoenlichkeitsmerkmale untersucht worden . Ferner wurden sie per Fragebogen nach ihren persoenlichen Begruendungen des Abbruchs befragt ."
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Psychotherapeut.00450292.ger.abstr | Psychotherapeut.00450292.ger.abstr | [
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"Der Stellenwert der Patientenzufriedenheit in der psychotherapeutischen Versorgung wird nach wie vor kontrovers diskutiert . Die vorliegende Arbeit stellt die Rolle des Konstrukts im Wechselspiel zwischen Effektivitaet , Oekonomie und Akzeptanz therapeutischer Massnahmen dar . Nach einem Ueberblick ueber verschiedene Verfahren zur Messung der Patientenzufriedenheit werden anhand von Daten aus der Qualitaetssicherung drei Validitaetsaspekte von Patientenzufriedenheit naeher untersucht . Anhand des ZUF-8 werden Beziehungen zwischen der Patientenzufriedenheit und den Behandlungsergebnissen , dem weiteren Inanspruchnahmeverhalten der Patienten sowie Aspekten der therapeutischen Arbeitsbeziehung untersucht . Hierbei zeigt sich , dass der Zusammenhang zwischen Behandlungsergebnissen und der Zufriedenheit nicht besonders gross ist . Im weiteren Inanspruchnahmeverhalten unterscheiden sich unzufriedene von zufriedenen Patienten . Der Zusammenhang zwischen der Zufriedenheit und der therapeutischen Arbeitsbeziehung ist hierbei zum Teil deutlich fuer einzelne Aspekte der Arbeitsbeziehung . Die gefundenen Effekte sind relativ gesehen sehr gross , absolut betrachtet fallen diese Effekte jedoch eher klein aus . Dies liegt v. a. an dem Umstand , dass nur sehr wenige Patienten im Anschluss an ihre Behandlung Unzufriedenheit aeussern ."
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Psychotherapeut.00450301.ger.abstr | Psychotherapeut.00450301.ger.abstr | [
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"Das interaktionelle Verstaendnis der Psychoanalyse , speziell das Konzept des dritten Punktes \" \" legen nahe , dass die Entwicklungen von Einsicht , Empathie und Beziehung als verschiedene Dimensionen des einen triangulierenden Prozesses , anzusehen sind , der das psychoanalytische Verstehen kennzeichnet . Von hieraus erscheint die psychoanalytische Methode , hier verstanden als Arbeit mit Widerstand , Uebertragung und Gegenuebertragung , nicht nur als ein Weg zur Erkenntnis , sondern auch als eine ebenso konfliktloesende wie ichstaerkende und damit speziell psychoanalytische Weise der hilfreichen Beziehungsbildung . Der Ausdruck \" Deutung aus der Gegenuebertragung \" bezeichnet eine Form psychoanalytischer Deutung , welche diesen Zusammenhang gezielt aufgreift , und dadurch bei neurotischen Konflikten auch fuer Kriseninterventionen genutzt werden kann . Dies wird an einem Fallbeispiel erlaeutert ."
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Psychotherapeut.00450308.ger.abstr | Psychotherapeut.00450308.ger.abstr | [
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"Die 1995 erstmals publizierten Ergebnisdokumentationsboegen zur berufsgruppeninternen Qualitaetssicherung werden mittlerweile in vielen psychosomatisch-psychotherapeutischen Fachkliniken routinemaessig eingesetzt . Bei ihrem Einsatz ist ausdruecklich eine modulare Ergaenzung bei speziellen Fragestellungen vorgesehen . In dieser zugrunde liegenden Studie wurde dies in zweierlei Hinsicht umgesetzt : Zum einen erfolgte eine Ergaenzung um Items , die sich auf die Religiositaet der Patienten und deren Auswirkung auf Krankheitsverstaendnis und allgemeines seelisches Wohlbefinden beziehen . Zum anderen wurde in Bezug auf den B1 - ( Aufnahme ) und den B2 - ( Entlassung ) Bogen ein dritter Bogen ( \" B3\") zur Erhebung einer Ein-Jahreskatamnese entwickelt . Resultate bezueglich der Praktikabilitaet der Durchfuehrung , der Therapieergebnisse sowie der Beantwortung der neu eingefuehrten Fragen zur Religiositaet werden vorgestellt . Der neu entwickelte \" B3\"-Bogen erwies sich als gut geeignetes Instrument fuer die katamnestische Untersuchung . Die Ergebnisse zeigen eine gute Akzeptanz der eingesetzten Frageboegen bei den Antwortern ( n=91 von 119 angeschriebenen Patienten ) und einen stabilen Therapieoutcome ."
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Psychotherapeut.60410001.ger.abstr | Psychotherapeut.60410001.ger.abstr | [
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"Die psychoanalytische Selbstpsychologie wird dargestellt als postmodernes Paradigma zur Analyse des postpatriarchalen Selbst mit dem methodischen Zugang ueber Introspektion und Empathie . Die eingeschraenkten Behandlungsmoeglichkeiten vor allem bei narzisstisch gestoerten Patienten fuehrte Heinz Kohut zur Annahme einer eigenen Entwicklungslinie des Narzissmus und eines Motivationsprimats des Selbst , welches er bipolar konzipierte . Sexuelles und aggressives Verhalten werden in der Folge nur dann als primaer angesehen , wenn ein kohaerentes , vitales , nicht fragmentiertes Selbst vorliegt . Wesentliche Bedingungen fuer Selbstkohaerenz sind die Selbstobjekterfahrungen , die in ihrer Vielfalt ebenso wie Selbststoerungen dargestellt werden . Aus den Selbstobjekterfahrungen leiten sich die Hauptuebertragungsformen in der psychoanalytischen Selbstpsychologie ab . Ein kurzer Abriss ueber den therapeutischen Prozess sowie ueber die Integration der Saeuglings- und Kleinkindforschung in die Selbstpsychologie und eine andere Sicht des Oedipuskomplexes vervollstaendigen die hier gegebene Uebersicht und werden abschliessend durch einige Neukonzeptionen der psychoanalytischen Selbstpsychologie ergaenzt ."
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Psychotherapeut.60410013.ger.abstr | Psychotherapeut.60410013.ger.abstr | [
{
"id": "Psychotherapeut.60410013.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Eine erste Uebersicht zu Risikofaktoren und protektiven Faktoren in der biographischen Entwicklung fuer spaetere psychische und psychosomatische Erkrankungen im Erwachsenenalter wird vorgestellt . Offene Fragen in bezug auf die Datenerhebung sowie deren Gewichtung und Evaluation werden angesprochen ."
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Psychotherapeut.60410017.ger.abstr | Psychotherapeut.60410017.ger.abstr | [
{
"id": "Psychotherapeut.60410017.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Es wird dargestellt , dass die multiple Persoenlichkeit bereits seit dem vorigen Jahrhundert bekannt ist und schon von Breuer und Freud sowie Kraepelin beschrieben wurde . Ueberwiegend wird die multiple Persoenlichkeit in der neueren und fast ausschliesslich angloamerikanischen Literatur den dissoziativen Symptomen im Rahmen von Borderlinestoerungen zugerechnet . Kritisiert wird die Anwendung des Begriffs Komorbiditaet . Anhand einiger Kasuistiken werden Hinweise auch zur Diagnostik gegeben . Nach Ansicht der Autoren sind hinreichende diagnostische Verfahren und Kriterien noch nicht vorhanden . Deren Entwicklung werden jedoch Grenzen auferlegt : Die fast stets vorhandene Anamnese von sexuellem Missbrauch kann bedeuten , dass ein Investigieren \" \" psychodynamisch die Wiederholung eines Missbrauchstraumas darstellt ."
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Psychotherapeut.60410025.ger.abstr | Psychotherapeut.60410025.ger.abstr | [
{
"id": "Psychotherapeut.60410025.ger.abstr-passage-0",
"type": "abstract",
"text": [
"Es wird ein Qualitaetssicherungsmodell ( QS-Modell ) fuer die stationaere Psychotherapie vorgestellt , das in enger Kooperation zwischen Forschern und Klinikern entwickelt wurde und dem vom Sachverstaendigenrat fuer die Konzertierte Aktion im Gesundheitswesen ( 1989 vorgeschlagenen Konzept ) einer internen QS mit externer Hilfestellung entspricht . Das Heidelberger Modell der Aktiven Internen QS besteht aus drei Komponenten : ( 1 ) einem Inventar zum routinemaessigen Monitoring der Qualitaet , ( 2 Regeln ) zur Ergebnisbewertung jedes einzelnen Patienten und ( 3 ) einem Kommunikationskonzept zur Rueckmeldung der Bewertungen an die Therapeuten . Besondere Aufmerksamkeit wird auf die Entdeckung und Dokumentation \" problematischer ' Behandlungsergebnisse gerichtet . Solche problematischen Verlaeufe werden bevorzugt - aber nicht ausschliesslich - an das therapeutische Team rueckgemeldet . Dies geschieht in Qualitaetszirkeln , in denen diese Faelle unter dem Gesichtspunkt der QS klinisch reflektiert werden . Diese individuumorientierte Rueckmeldung und klinische Besprechung wird anhand von drei Beispielfaellen diskutiert . Das Heidelberger Modell wird als Basis einer QS in der Psychotherapie gesehen , die sowohl das Ziel einer Qualitaets \" sicherung und -verbesserung \" hat als auch dem Ziel einer moeglichst rationalen psychotherapeutischen Versorgung verpflichtet ist ."
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Psychotherapeut.60410036.ger.abstr | Psychotherapeut.60410036.ger.abstr | [
{
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"type": "abstract",
"text": [
"Psychosomatische Diagnostik zielt darauf ab , die Indikationsentscheidung und das therapeutische Handeln zu fundieren . Dafuer hat sich in der klinischen Arbeit das Konzept der Simultandiagnostik bewaehrt , welches die verschiedenen Facetten der diagnostischen und therapeutischen Aufmerksamkeit buendelt : Koerper vs. Psyche , Psychodynamik vs. Familiendynamik und Institution vs. Individuum . Es erfordert ein adaptives Vorgehen , welches auf die spezifische Situation des Patienten abgestellt ist und beruecksichtigt , dass der Therapeut selbst Instrument der Diagnostik ist . Dieser Beitrag stellt das Konzept der Simultandiagnostik am Beispiel der Praxis einer psychosomatischen Klinik dar . Der Stellenwert operationaler Klassifikationssysteme wird vor dem Hintergrund praxisbegleitender empirischer Forschung diskutiert ."
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"In diesem kurzen Artikel versuche ich einige wichtige Einsichten aus meiner Laufbahn als Forscher und Praktiker im Bereich der Psychotherapie zu skizzieren : Der Schluessel zu einer erfolgreichen Therapie ist ohne Zweifel die Faehigkeit des Therapeuten , empathisch zuzuhoeren , verbunden mit einer Reihe anderer positiver Attribute und sorgfaeltig ausgebildeter interpersonaler Fertigkeiten . Ein Blick auf die Sollseite des therapeutischen Geschehens verdeutlicht , dass Feindseligkeiten des Patienten haeufig eine Gegenfeindseligkeit beim Therapeuten provozieren , die nicht selten zu einem negativen Therapieergebnis fuehrt ."
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"Es wird der Versuch unternommen , dass klassische Konzept der Konversion unter Einbeziehung psychodynamischer Auffassungen zu operationalisieren . Im Hintergrund steht die wachsende Evidenz , dass Konversionsvorgaenge ueber die hysterische Psychodynamik weit hinausreichen . Der Operationalisierungsentwurf ist restriktiv entworfen , um gezielt die profuse Ausweitung und damit Entwertung des Konzepts zu verhindern . Der Operationalisierungsvorgang wird in drei Schritten nachvollziehbar gemacht . Ausgehend von einer Konsensusdefinition wird ueber die Darstellung von 11 dynamischen Elementen des Konversionskonstrukts versucht , seine Komplexitaet herabzusetzen , um dann in die eigentliche Operationalisierung ueberzuleiten ."
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Psychotherapeut.60410095.ger.abstr | Psychotherapeut.60410095.ger.abstr | [
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"Die Psychoanalyse verfuegt ueber die laengste Tradition in der psychotherapeutischen Behandlung von Krebskranken . Schon fruehzeitig wurden bei organisch Schwerkranken Modifikationen im Behandlungssetting und Therapieprozess fuer erforderlich gehalten . Freyberger und Speidel ( 1976 ) trugen wesentlich zur Entwicklung dieser Supportiven Psychotherapie \" \" bei . Neuere Entwicklungen der stuetzenden Einzeltherapie \" \" werden aufgewiesen . Ihre besonderen Vorzuege im Vergleich zu den derzeit am meisten verbreiteten Gruppenunterstuetzungsprogrammen fuer Krebskranke werden deutlich gemacht ."
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Psychotherapeut.60410099.ger.abstr | Psychotherapeut.60410099.ger.abstr | [
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"Seit den 20er Jahren entwickelten sich in der Psychotherapie verschiedene Ansaetze , den Koerper in die Behandlung einzubeziehen . Drei Grundrichtungen sind dabei erkennbar , die unterschiedliche Koerperbilder beinhalten : Auf Wilhelm Reich geht die Arbeit mit dem energetisch-expressiven Koerper zurueck , auf Elsa Gindler , die Reformgymnastik und den Ausdruckstanz die Arbeit mit dem sich erkundenden und bewegenden Koerper und auf Sándor Ferenczi die dialogische Arbeit mit dem Koerper in der therapeutischen Beziehung . Aus diesen drei Grundrichtungen stammen verschiedene koerperpsychotherapeutische Schulen und Methoden , die in der juengsten Zeit wieder mehr beachtet und diskutiert werden . Ihre klinische Bedeutung ist nicht , wie zuweilen beschrieben , auf die Behandlung praeverbaler oder psychosomatischer Stoerungen begrenzt . Sie helfen , therapeutische Prozesse zu veranschaulichen , zu vertiefen und leibhaftig erlebbar werden zu lassen ."
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"Ernst Simmel gehoerte zu einem kleinen Kreis frueher Psychoanalytiker , die sich mit grosser Begeisterung und in produktiver Orthodoxie \" \" um die klinische Anwendung psychoanalytischer Prinzipien in der Medizin bemuehten . Konsequenterweise ist er der Begruender einer ersten psychoanalytischen Poliklinik 1919 in Berlin und eines ersten psychoanalytischen Krankenhauses ( \" Sanatorium Schloss Tegel \" ) 1927 in Deutschland . Fast gleichzeitig formulierte er 1926 das Profil eines psychotherapeutischen Facharztes . Ihn als Pionier wieder zu entdecken , kann darueber hinaus als Versuch verstanden werden , das Trauma des Nationalsozialismus mit den Folgen verschiedenster historischer Spaltungen der Fachgesellschaften zu ueberwinden . Er ist generationsuebergreifend eine glaubwuerdige berufspolitische Identifikationsfigur , insbesondere fuer den neuen Facharzt fuer Psychotherapeutische Medizin \" . \" Dennoch sollte die Hervorhebung Simmels nicht dazu fuehren , dass der etwa 60 weiteren Pioniere einer psychotherapeutischen Medizin , die Deutschland aufgrund ihrer juedischen Abstammung zwangsweise verlassen mussten , nicht mehr gebuehrend gedacht wird ."
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Psychotherapeut.60410139.ger.abstr | Psychotherapeut.60410139.ger.abstr | [
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"Die urspruenglich von John Bowlby entwickelte Bindungstheorie gewinnt zunehmend an Relevanz im Bereich der Psychotherapie ( forschung ) . Diese Uebersicht beginnt mit einer Klaerung der zentralen Begriffe und Annahmen dieser Theorie und fasst einige Befunde zur Entwicklung und den Korrelaten von Bindung zusammen , die vornehmlich aus entwicklungspsychologischen Untersuchungen stammen . Uebertragen auf Erwachsene , beduerfen die Konzepte der Bindungstheorie einer Revision , die in dieser Arbeit skizziert wird . Schliesslich werden auf dieser Basis einige heute uebliche Methoden zur Erfassung von Bindungsstilen und Bindungsverhalten im Erwachsenenalter dargestellt , die bei Untersuchungen im klinischen Feld ( Inhalt des 2. Teils der Uebersichtsarbeit ) eine wichtige Rolle spielen ."
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Psychotherapeut.60410151.ger.abstr | Psychotherapeut.60410151.ger.abstr | [
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"Am Anfang des Begriffs und der klassischen Induktionstechnik der Hypnose steht der schottisch-englische Arzt und Forscher James Braid , dessen Geburtstag sich 1995 zum 200. Male jaehrte . Braid hat in Auseinandersetzung mit dem Mesmerismus und der Fluidumtheorie eine eigenstaendige Auffassung des hypnotischen Prozesses auf neurophysiologischer Grundlage entwickelt und das klinische Verfahren der Hypnose ausgearbeitet und standardisiert . Waehrend ihm in England zunaechst weitergehende Anerkennung versagt blieb , hat der Braidismus \" \" in Deutschland ab 1880 durch die Uebersetzungen des Physiologen Preyer viel Beachtung gefunden ; etwa zeitgleich setzte in Frankreich durch Charcot und seine Kontrahenten eine intensive Beschaeftigung mit der Hypnose ein . Braid als der eigentliche Inaugurator dieser klinischen Methode ist darueber fuer Jahrzehnte in den Hintergrund gerueckt ; daher soll hier erneut an ihn und seine epochalen Leistungen als Wegebereiter der Psychotherapie erinnert werden ."
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Psychotherapeut.60410156.ger.abstr | Psychotherapeut.60410156.ger.abstr | [
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"id": "Psychotherapeut.60410156.ger.abstr-passage-0",
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"text": [
"Ein Fuehrungsseminar ( Wuerttembergische Verwaltungs- und Wirtschaftsakademie , Stuttgart ) fuer leitende Aerzte in Krankenhaeusern im Oktober vergangenen Jahres machte die Aktualitaet des 1961 erstmals erschienenen Buches Erfahrungen in Gruppen ( Bion 1991 ) deutlich . Im folgenden sollen daher die in diesem Seminar vorgestellten Fuehrungsprinzipien als Aufhaenger dienen , Bions Erfahrungen in Gruppen noch einmal in Erinnerung zu rufen und zudem ihre Anwendbarkeit auch auf das einzelne Individuum aufzuzeigen ."
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Psychotherapeut.60410169.ger.abstr | Psychotherapeut.60410169.ger.abstr | [
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"Zunehmend wird die Psychodynamik von Patientinnen und Patienten mit schweren Persoenlichkeitsstoerungen , Essstoerungen oder \" hysterischen \" Symptombildungen als Verarbeitung traumatischer Kindheits- und Jugenderfahrungen wie Missbrauch oder Misshandlung verstehbar . Dissoziation mit induzierter Depersonalisation , Derealisation und Personifizierung nur guter und nur schlechter Objekte ist der zentrale Copingmechanismus waehrend und nach einer traumatischen Erfahrung . Nicht assimilierbare Erinnerungen an Traumata wirken retraumatisierend und muessen abgewehrt werden etwa durch Essstoerungen , Substanzabusus , selbstverletzendes Verhalten oder soziales \" Agieren \" . Auf diesem psychodynamischen Hintergrund stellen wir eine Traumatherapie dar , die Erfahrungen der Hypnotherapie und der Katathym-imaginativen Psychotherapie umsetzt : In der Vorbereitungsphase wird in der Imagination Ressourcen-orientiert ein sicherer innerer Ort und der Kontakt zu inneren Helfern geschaffen . Die eigentliche Traumaarbeit besteht in einem dosierten , stabil konfrontierenden , aber moeglichst wenig retraumatisierenden Heranfuehren an die traumatischen Szenen , gefolgt von innerem Trost und Hinter-sich-lassen . In der Abschlussphase geht es wieder um die Ressourcen-orientierte Hinwendung zu Kreativitaet und konkreter Lebensplanung ."
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Psychotherapeut.60410275.ger.abstr | Psychotherapeut.60410275.ger.abstr | [
{
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"Diese Arbeit gibt einen Ueberblick ueber die psychotherapeutischen und pharmakologischen Behandlungsstrategien bei Anorexia und Bulimia nervosa . Besonders hervorgehoben werden dabei die vorhandenen kontrollierten Therapiestudien . Psychotherapie stellt bei beiden Essstoerungen die Therapie erster Wahl dar . Meist werden \" Behandlungspakete \" angeboten , die versuchen , der Komplexitaet der Stoerungen gerecht zu werden . Bei der Bulimia nervosa sind die Kurz- und Langzeiterfolge vor allem der kognitiven Verhaltenstherapie ( KVT ) , in letzter Zeit auch der interpersonellen Psychotherapie ( IPT ) , gut abgesichert . Medikamentoese Therapie mit Antidepressiva gilt als Methode zweiter Wahl . Neuere Untersuchungen sprechen fuer ein stufenweises Vorgehen , wobei niederschwellige Therapien , wie Selbsthilfemanuale , einen ersten Zugang darstellen koennten . Bei der Anorexia nervosa gibt es nur wenige kontrollierte Studien . Operante Methoden zur Gewichtsrestitution gelten heute als unverzichtbarer Bestandteil der ambulanten wie stationaeren Therapie . Familientherapeutische kognitiv-verhaltenstherapeutische und psychodynamische Therapieverfahren , haben sich in der Praxis bewaehrt , sind aber bisher nur ungenuegend durch kontrollierte Studien evaluiert . Von einer routinemaessigen medikamentoesen Therapie der Anorexia nervosa muss beim derzeitigen Kenntnisstand abgeraten werden ."
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Psychotherapeut.60410297.ger.abstr | Psychotherapeut.60410297.ger.abstr | [
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"Auf der Grundlage der bisherigen Modelle zur psychodynamischen Diagnostik und der psychoanalytischen Interviewtechnik sowie den theoretischen Konzepten der fuenf Achsen der OPD-Diagnostik wird eine psychodynamisch-diagnostische Untersuchung konzeptualisiert . Die Untersuchung ist in fuenf Phasen strukturiert : Eroeffnung Ermittlung , von Beziehungsepisoden , von Selbsterleben , von Objekterleben und der Psychotherapiemotivation sowie Behandlungsvoraussetzungen und Einsichtsfaehigkeit . Die syndromale Diagnostik nach ICD 10 wird in einer abschliessenden Phase ermittelt . Die entwickelte psychodynamisch-diagnostische Untersuchung kann als Erstinterview oder auch in spaeteren Phasen eingesetzt werden . Sie wird ueber die OPD-Diagnostik hinaus auch zur klinischen Anwendung empfohlen ."
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Psychotherapeut.60410305.ger.abstr | Psychotherapeut.60410305.ger.abstr | [
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"Vorgeschlagen wird ein zweidimensionales Modell zum identitaetstheoretischen Verstaendnis von Neurosen und Persoenlichkeitsstoerungen . Die erste Dimension dient zur Beschreibung der Symptomatik zwischen den Polen Angst und Depressivitaet . Die zweite hierzu senkrecht stehende Dimension bezeichnet den Reifegrad der Identitaetsintegration zwischen den Extremen reife neurotische Persoenlichkeitsorganisation und schwere Persoenlichkeitsstoerung . Spezifische Stoerungsbilder lassen sich durch Zuordnung auf beiden Achsen in dieses Modell einordnen ."
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