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Teigeler M, Schaudien D, Böhmer W, Länge R, Schäfers C. Effects of the Gestagen Levonorgestrel in a Life Cycle Test with Zebrafish (Danio rerio). Environ Toxicol Chem 2022; 41:580-591. [PMID: 33539028 DOI: 10.1002/etc.5008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/25/2020] [Accepted: 01/31/2021] [Indexed: 06/12/2023]
Abstract
The amount of pharmaceuticals transferred to the aquatic environment via municipal and hospital waste water is steadily increasing. The progress in medical research has resulted in the manufacture of active substances of increased stability, specificity, and potency, which can trigger adverse effects in aquatic organisms. Moreover, advanced analytical methods allow the detection of pharmaceuticals in environmental matrices at very low concentrations, which increases the number of substances to be assessed. Levonorgestrel is a synthetic gestagen commonly used in medicinal products for contraception. Because progestogenic compounds could have an impact on fish maturation processes, a life cycle test was performed to assess the effects of levonorgestrel exposure of the embryonic to the adult stages of zebrafish (Danio rerio) at mean measured concentrations of 0.06, 0.16, 0.47, 1.64, and 5.45 ng/L. Apical endpoints were survival, growth, reproduction, and sex ratio. Determination of endocrine modulation was completed by measurement of vitellogenin and 11-keto testosterone in blood plasma, as well as by histopathological analysis of gonads. For all parameters, control values were within the recommended quality range. The most prominent levonorgestrel effect was a shift toward an increased number of male fish at 1.64 and especially 5.45 ng/L, at which point all fish were histologically determined to be males and no spawning occurred; 11-keto testosterone was significantly decreased. A no-observed-effect concentration (NOEC) of 0.47 ng levonorgestrel/L was confirmed by the fertilization capability of adult fish, the male maturation stages, and female gonad histopathology. Whereas hatch and juvenile growth were not affected, posthatch survival was significantly impeded at ≥0.47 ng levonorgestrel/L, although it was not clearly related to the test concentration. For male length and weight, the same NOEC of 0.16 ng/L was obtained at study termination. Environ Toxicol Chem 2022;41:580-591. © 2021 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.
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Affiliation(s)
- Matthias Teigeler
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Schmallenberg, Germany
| | - Dirk Schaudien
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover, Germany
| | - Walter Böhmer
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Schmallenberg, Germany
| | | | - Christoph Schäfers
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Schmallenberg, Germany
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Brüggemann M, Hund-Rinke K, Böhmer W, Schaefers C. Development of an Alternative Test System for Chronic Testing of Lotic Macroinvertebrate Species: A Case Study with the Insecticide Imidacloprid. Environ Toxicol Chem 2021; 40:2229-2239. [PMID: 33844353 DOI: 10.1002/etc.5070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/14/2021] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
There are currently few suitable test systems for the chronic toxicity testing of aquatic macroinvertebrates under stream conditions. Therefore, a new test system mimicking running water conditions was developed for testing with lotic insects. This system uses small test cages, with 10 of these suspended inside each 25-L container and rotating at 0.1 m/s, to create a water flow for the individual organism inside each cage. To test the performance of the new exposure system, chronic effects (21 d) of the neonicotinoid imidacloprid were investigated with field-collected larvae of the stonefly Protonemura sp. Endpoints were survival, growth, and/or emergence (depending on the developmental stage of the larvae at the start of the exposure). Two experiments conducted 1 yr apart showed good reproducibility: growth 10% effect concentration (EC10) values were 15.3 and 18.5 μg/L and no-observed-effect concentration (NOEC) values were 30.3 and 21.5 μg/L. A third experiment, performed with further-developed larval instars, showed a significant effect of imidacloprid on emergence (with EC10 of 5.97 μg/L and NOEC of 2.89 μg/L) and a significant effect on survival (with median lethal concentration of 44.7 µg/L). The results of the present study show that the newly developed test system provides a suitable approach for toxicity testing with stonefly larvae and potentially for other lotic macroinvertebrate species. Environ Toxicol Chem 2021;40:2229-2239. © 2021 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.
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Affiliation(s)
- Maria Brüggemann
- Fraunhofer Institute for Molecular Biology and Applied Ecology, Schmallenberg, Germany
| | - Kerstin Hund-Rinke
- Fraunhofer Institute for Molecular Biology and Applied Ecology, Schmallenberg, Germany
| | - Walter Böhmer
- Fraunhofer Institute for Molecular Biology and Applied Ecology, Schmallenberg, Germany
| | - Christoph Schaefers
- Fraunhofer Institute for Molecular Biology and Applied Ecology, Schmallenberg, Germany
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Hering I, Eilebrecht E, Parnham MJ, Weiler M, Günday-Türeli N, Türeli AE, Modh H, Heng PWS, Böhmer W, Schäfers C, Fenske M, Wacker MG. Microparticle formulations alter the toxicity of fenofibrate to the zebrafish Danio rerio embryo. Aquat Toxicol 2021; 234:105798. [PMID: 33799113 DOI: 10.1016/j.aquatox.2021.105798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
A wide variety of active pharmaceutical ingredients are released into the environment and pose a threat to aquatic organisms. Drug products using micro- and nanoparticle technology can lower these emissions into the environment by their increased bioavailability to the human patients. However, due to this enhanced efficacy, micro- and nanoscale drug delivery systems can potentially display an even higher toxicity, and thus also pose a risk to non-target organisms. Fenofibrate is a lipid-regulating agent and exhibits species-related hazards in fish. The ecotoxic effects of a fenofibrate formulation embedded into a hydroxypropyl methylcellulose microparticle matrix, as well as those of the excipients used in the formulation process, were evaluated. To compare the effects of fenofibrate without a formulation, fenofibrate was dispersed in diluted ISO water alone or dissolved in the solvent DMF and then added to diluted ISO water. The effects of these various treatments were assessed using the fish embryo toxicity test, acridine orange staining and gene expression analysis assessed by quantitative RT polymerase chain reaction. Exposure concentrations were assessed by chemical analysis. The effect threshold concentrations of fenofibrate microparticle precipitates were higher compared to the formulation. Fenofibrate dispersed in 20%-ISO-water displayed the lowest toxicity. For the fenofibrate formulation as well as for fenofibrate added as a DMF solution, greater ecotoxic effects were observed in the zebrafish embryos. The chemical analysis of the solutions revealed that more fenofibrate was present in the samples with the fenofibrate formulation as well as fenofibrate added as a DMF solution compared to fenofibrate dispersed in diluted ISO water. This could explain the higher ecotoxicity. The toxic effects on the zebrafish embryo thus suggested that the formulation as well as the solvent increased the bioavailability of fenofibrate.
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Affiliation(s)
- Indra Hering
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany; Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Auf dem Aberg 1, 57392, Schmallenberg, Germany; Goethe University Frankfurt am Main, Department Aquatic Ecotoxicology, Max-von-Laue-Str. 13, 60438, Frankfurt am Main, Germany.
| | - Elke Eilebrecht
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Auf dem Aberg 1, 57392, Schmallenberg, Germany
| | - Michael J Parnham
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Marc Weiler
- MyBiotech GmbH, Industriestraße 1B, 66802, Überherrn, Germany
| | | | | | - Harshvardhan Modh
- National University of Singapore, Department of Pharmacy, Faculty of Science, Wet Science Building (S9), 5 Science Drive 2, 117546, Singapore, Singapore
| | - Paul W S Heng
- National University of Singapore, GEA-NUS Pharmaceutical Processing Research Laboratory, Department of Pharmacy, Faculty of Science, 18 Science Drive 4, 117543, Singapore, Singapore
| | - Walter Böhmer
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Auf dem Aberg 1, 57392, Schmallenberg, Germany
| | - Christoph Schäfers
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Auf dem Aberg 1, 57392, Schmallenberg, Germany
| | - Martina Fenske
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.
| | - Matthias G Wacker
- National University of Singapore, Department of Pharmacy, Faculty of Science, Wet Science Building (S9), 5 Science Drive 2, 117546, Singapore, Singapore
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Pickford DB, Finnegan MC, Baxter LR, Böhmer W, Hanson ML, Stegger P, Hommen U, Hoekstra PF, Hamer M. Response of the mayfly (Cloeon dipterum) to chronic exposure to thiamethoxam in outdoor mesocosms. Environ Toxicol Chem 2018; 37:1040-1050. [PMID: 29105812 DOI: 10.1002/etc.4028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/12/2017] [Accepted: 11/02/2017] [Indexed: 06/07/2023]
Abstract
Thiamethoxam is a widely used neonicotinoid insecticide that has been detected in surface water monitoring programs in North America and Europe. This has led to questions about its toxicity to nontarget insects, specifically those with an aquatic life stage. To address the uncertainty associated with possible impacts from environmental exposures, a chronic (35-d) outdoor mesocosm study with a formulated product containing thiamethoxam was conducted. The specific focus of the study was the response of mayflies (Ephemeroptera), which have been reported to be particularly sensitive in laboratory studies. A range of concentrations (nominally 0.1, 0.3, 1.0, 3.0, and 10.0 µg/L thiamethoxam), plus untreated controls were tested, and the abundance and emergence of mayflies (Cloeon dipterum) were assessed weekly for 35 d. Mean measured time-weighted average exposures were within 6% of nominal over the duration of the study, with the mean half-life of thiamethoxam in each treatment ranging from 7 to 13 d. Statistically significant reductions in both larval abundance and adult emergence were observed at 10.0, 3.0, and 1.0 μg/L following 1, 2, and 3 wk of exposure, respectively. Exposure to 0.1 and 0.3 µg/L thiamethoxam had no statistically significant effect on larval mayfly abundance or adult emergence at any point in the study. These findings support a 35-d no-observed-effect concentration (NOEC) of 0.3 µg thiamethoxam/L for mayflies (C. dipterum) under chronic conditions. Furthermore, because the 95th percentile of environmental concentrations has been reported to be 0.054 µg/L, these results indicate that populations of C. dipterum and similarly sensitive aquatic insects are unlikely to be significantly impacted by thiamethoxam exposure in natural systems represented by the conditions in our study. Environ Toxicol Chem 2018;37:1040-1050. © 2017 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals, Inc. on behalf of SETAC.
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Affiliation(s)
- Daniel B Pickford
- Syngenta, Jealott's Hill International Research Centre, Bracknell, United Kingdom
| | - Meaghean C Finnegan
- Syngenta, Jealott's Hill International Research Centre, Bracknell, United Kingdom
| | | | - Walter Böhmer
- Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Schmallenberg, Germany
| | - Mark L Hanson
- Department of Environment and Geography, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Petra Stegger
- Institut für Gewässerschutz-Mesocosm, Homberg/Ohm, Germany
| | - Udo Hommen
- Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Schmallenberg, Germany
| | | | - Mick Hamer
- Syngenta, Jealott's Hill International Research Centre, Bracknell, United Kingdom
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Rüdel H, Böhmer W, Müller M, Fliedner A, Ricking M, Teubner D, Schröter-Kermani C. Retrospective study of triclosan and methyl-triclosan residues in fish and suspended particulate matter: results from the German Environmental Specimen Bank. Chemosphere 2013; 91:1517-1524. [PMID: 23336923 DOI: 10.1016/j.chemosphere.2012.12.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 12/17/2012] [Accepted: 12/21/2012] [Indexed: 06/01/2023]
Abstract
A retrospective monitoring of triclosan (TCS; period 1994-2003 and 2008) and its potential transformation product methyl-triclosan (MTCS; period 1994-2008) was performed using archived fish samples from German rivers (16 sites, including Elbe and Rhine). At four of these sites suspended particulate matter (SPM) was also investigated covering the period 2005-2007. Samples were analyzed by GC/MS, either directly (MTCS) or after derivatization (TCS). TCS burdens of fish muscle tissue ranged from <0.2-3.4 ng g(-1) ww (wet weight; corresponding to <2-69 ng g(-1) lw, lipid weight) without apparent concentration trends over time. MTCS was detected at considerably higher concentrations in fish ranging from 1.0-33 ng g(-1) ww (47-1010 ng g(-1) lw) and increased until about 2003-2005. Thereafter, concentrations generally were lower, although at some sites single higher values were observed in recent years. In SPM, decreasing MTCS concentrations in the range 1-4 ng g(-1) dry weight were detected while TCS was always below the limit of quantification. Assuming that MTCS concentrations are correlated to TCS consumption, the observed decrease in MTCS levels may be partly a result of the voluntary renunciation of TCS use in detergents for, e.g., laundry or dishwashing declared by a manufacturers' association in 2001. Because of a lack of ecotoxicity studies for MTCS, a QSAR-derived predicted no effect concentration (PNEC) was compared to averaged ambient water concentrations of fish which were calculated from maximum tissue residues by applying an appropriate bioconcentration factor from literature. Since these calculated water concentrations were below the PNEC it is assumed that MTCS alone poses no immediate risk to aquatic organism. The conversion to a PNEC for SPM organisms and comparison with detected SPM levels of MTCS also revealed no risk.
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Affiliation(s)
- Heinz Rüdel
- Fraunhofer Institute for Molecular Biology and Applied Ecology (Fraunhofer IME), 57392 Schmallenberg, Germany.
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Rüdel H, Böhmer W, Schröter-Kermani C. Retrospective monitoring of synthetic musk compounds in aquatic biota from German rivers and coastal areas. ACTA ACUST UNITED AC 2006; 8:812-23. [PMID: 16896465 DOI: 10.1039/b602389b] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The polycyclic musk compounds HHCB (Galaxolide) and AHTN (Tonalide) are commonly used as synthetic fragrances in personal care products and household cleaners. These and other synthetic musk fragrances were quantified in different aquatic samples from the German Environmental Specimen Bank (ESB). While HHCB and AHTN were found in almost all samples, most of the other musk fragrances were detected only in a few samples and mostly at lower concentration levels. Blue mussels from the North Sea showed varying levels of 0.5-1.7 ng g(-1) ww for HHCB and 0.4-2.5 ng g(-1) ww for AHTN (ww, wet weight) in the period from 1986 to 2000, while blue mussels from the Baltic Sea were only slightly contaminated with synthetic musk fragrances. Lipid weight-related concentrations of synthetic musk compounds in blue mussels were higher than in eelpout muscles, bladder wrack and herring gull eggs. In comparison to the marine specimens, muscles of bream from German rivers had higher concentrations of HHCB and AHTN. The ranges of HHCB and AHTN concentrations in bream from the Elbe River were 545-6400 ng g(-1) lw and 48-2130 ng g(-1) lw, respectively (lw, lipid weight; five sampling sites, period 1993-2003). In the Rhine River, HHCB and AHTN levels of bream muscles were highest at the Iffezheim site (up to 9750 ng g(-1) lw HHCB, 1998). Even higher synthetic musk levels were detected in bream from the rivers Saale and Saar. In recent years, levels of both compounds determined in bream from most sampling sites have decreased from maximum values in the 1990s. As the concentrations of AHTN have decreased faster, the ratio of HHCB to AHTN increased from 2-4 in the 1990s to 10-20 in recent years.
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Affiliation(s)
- Heinz Rüdel
- Fraunhofer Institute for Molecular Biology and Applied Ecology (Fraunhofer IME), 57377, Schmallenberg, Germany.
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Wenzel A, Böhmer W, Müller J, Rüdel H, Schröter-Kermani C. Retrospective monitoring of alkylphenols and alkylphenol monoethoxylates in aquatic biota from 1985 to 2001: results from the German Environmental Specimen Bank. Environ Sci Technol 2004; 38:1654-1661. [PMID: 15074671 DOI: 10.1021/es035032b] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Breams (Abramis brama) and zebra mussels (Dreissena polymorpha) from freshwater, and common mussels (Mytilus edulis) from marine ecosystems, archived in the German Environmental Specimen Bankwere analyzed for the presence of 4-nonylphenol (NP), 4-tert-octylphenol (OP), nonylphenol monoethoxylate (NP1EO), and octylphenol monoethoxylate (OP1EO). The samples were collected in the German rivers Elbe, Rhine, and Saar, and in Lake Belau between 1992 and 2001, as well as in the North Sea and Baltic Sea between 1985 and 2001. The main purpose of the study was to investigate the effectiveness of imposed reduction measures regarding the use of alkylphenol ethoxylates. NP1EO and OP were detected in all breams. NP was predominantly above the limit of quantification (LOQ, 2 ng/g; all data on a wet weight basis), and OP1EO was mostly below the LOQ (0.2 ng/g). Maximal concentrations of 112 ng/g NP, 259 ng/g NP1EO, 5.5 ng/g OP, and 2.6 ng/g OP1EO were found in Saar breams from 1994. NP was detected in all zebra mussels from the river Elbe (up to 41 ng/g), whereas in rather few samples OP and NP1EO were found at low levels. OP1EO was not detected in any sample. Concentrations in mussels and breams from the reference site Lake Belau were below the LOQ for all compounds. In marine biota NP was found until 1997 with maximum concentrations up to 9.7 ng/g, whereas NP1EO was detected at levels between 1.7 and 12.9 ng/g in very few samples collected at the end of the 1980s. A tendency of the concentrations to decrease was obvious for all sampling sites; it was most pronounced for NP1EO and NP after 1996/1997. The effectiveness of the reduction measures is most evident at the Saar sampling site Güdingen and the North Sea sampling site Eckwarderhörne.
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Affiliation(s)
- Andrea Wenzel
- Fraunhofer Institute for Molecular Biology and Applied Ecology, 57377 Schmallenberg, Germany.
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Dörfler T, Schmidt-Ott W, Hild T, Mehren T, Böhmer W, Möller P, Pfeiffer B, Rauscher T, Kratz K, Sorlin O, Borrel V, Grévy S, Guillemaud-Mueller D, Mueller AC, Pougheon F, Anne R, Lewitowicz M, Ostrowsky A, Robinson M, Saint-Laurent MG. Neutron-rich isotopes 54-57Ti. Phys Rev C Nucl Phys 1996; 54:2894-2903. [PMID: 9971660 DOI: 10.1103/physrevc.54.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Böhmer W. [Ethical problems in medical treatment from the medical history viewpoint]. Med Klin (Munich) 1988; 83:769-73. [PMID: 3070316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Chergui M, Schwentner N, Böhmer W, Haensel R. Observation of the Rydberg states of NO trapped in an argon matrix. Phys Rev A Gen Phys 1985; 31:527-529. [PMID: 9895514 DOI: 10.1103/physreva.31.527] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Schoene K, Böhmer W, Steinhanses J. Determination of vapour pressures down to 0.01 Pa by headspace gas-chromatography. ACTA ACUST UNITED AC 1984. [DOI: 10.1007/bf00487068] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Böhmer W, Kirsten F. [Extensions of the Reformation of Martin Luther to public health in his time]. Z Gesamte Inn Med 1983; 38:546-51. [PMID: 6362241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The reformation as the decisive social change during the first half of the 16th century influenced directly also the organisational forms of the contemporary social welfare and indirectly the development of public health of that time. By evaluation of still existing account health of that time. By evaluation of still existing account-books of the Gemeinen Kasten the changes in the provision of the poor and the development of the old hospitals caused by reformation were investigated. Here the personal influence of Martin Luther is shown.
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Böhmer W. [The 1610 Wittenberg cesarean section]. Zentralbl Gynakol 1983; 105:1265-1270. [PMID: 6359787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Explanation of the references and reports of eyewitnesses about the caesarean section performed in Wittenberg of April 21st, 1610. Probably this operation will have been not the first one, but certainly the first medically well documented one on an alive woman.
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Böhmer W. [Diagnostic errors in tubal pregnancy]. Z Arztl Fortbild (Jena) 1974; 68:493-5. [PMID: 4471667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Böhmer W. [On differential diagnosis of hyperemesis gravidarum. (A clinical case contribution)]. Zentralbl Gynakol 1967; 89:968-73. [PMID: 5590301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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