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Biomedical subjects

C Gutenbrunner

Publications and source records attributed to C Gutenbrunner.

18 recordsLinked to original sources
PubMed2006

Forty-two-years later: the outcome of childhood-onset schizophrenia.

This paper describes the long-term course of 76 patients who had been consecutively admitted to the Department of Child and Adolescent Psychiatry, Philipps University, between 1920 and 1961 with a suspected diagnosis of childhood-onset schizophrenia. By means of a consensus analysis of available data in accordance with ICD-10 criteria, the diagnosis of schizophrenia was confirmed in only 50% of the original sample (n = 38, childhood-onset schizophrenia group); whereas the rest of the sample were allotted other diagnoses (n = 38, non-schizophrenia group). A follow-up investigation was conducted, interviewing all available patients, if possible, or their first-degree relatives or doctors. In the childhood-onset schizophrenia group, age at onset (mean +/- S.D.) was 12.7 +/- 2.5 (range 5-14) years and age at follow-up was 55.0 +/- 4.8 (range 42-62) years. The outcome of this group was poor. According to the Global Assessment Scale (GAS), only 16% had a good (GAS score 71-100) and 24% had a moderate (GAS score 41-70) outcome. In the 16 childhood-onset schizophrenia patients who could be personally investigated at follow-up, 10 (62.5%) displayed severe or moderate depressive symptoms according to the BPRS depressive score. The death rate (including suicide) was significantly higher in the schizophrenia group (n = 15; 39.5%) than in the non-schizophrenia group (n = 7; 18.4%). A comparison of the life-time diagnoses of the total sample (n = 76) at follow-up with the ICD-10 diagnoses made retrospectively revealed a diagnostic stability in 69 (91%) and a change of diagnosis in 7 (9%) cases, among them 4 who were originally diagnosed as having childhood-onset schizophrenia.

Adolescent↗
PubMed2005

[Significance of the chronic fatigue syndrome in rehabilitation medicine--status and perspectives].

It appears that from a clinical point of view chronic exhaustion or fatigue is an important factor in rehabilitation. This is, however, first of all a phenomenon that can be described as a function in accordance with the International Classification of Functioning, Disability and Health (JCF), caused by chronic illnesses or chronic excessive stress. The clinical and sociomedical ranking of chronic fatigue or exhaustion in respect of rehabilitation was discussed in the framework of a Workshop at the 12th Rehabilitation Science Colloquium, 2003 from the viewpoints of psychiatric rehabilitation, methodology, sociology and practical rehabilitation, and conclusions for future research were drawn. The definition of chronic fatigue is first of all mainly based on the feeling of chronic tiredness but also on phenomena of disturbed concentration, physical discomfort, headache and disorders of "drive" and mood. A psychiatric diagnosis linked with symptoms of chronic fatigue is neurasthenia, which is arrived at according to precisely defined criteria. Depressive disorder is one of the most important differential diagnoses in this sphere. Examinations by general practitioners revealed that about 90 % of the patients who had been diagnosed as suffering from psychovegetative disorders completely agreed with the diagnosis of neurasthenia. Neurasthenia resulted more often in work disability periods than disorders of somatisation and other psychosomatic diagnoses. Basing on the "IRES" scale "vital exhaustion", singular of even serious changes become evident in about 50 % to 90 % of the patients undergoing rehabilitation, depending on their individual range of indications. As was to be expected, the majority of pathologic findings concerns patients undergoing psychosomatic rehabilitation, since in such cases there is an overlapping with symptoms of psychosomatic diseases. It is, however, remarkable that also in somatically oriented orthopaedic rehabilitation symptoms of fatigue are seen in up to 50 % of the patients. Preliminary studies have shown that these symptoms can be definitely ameliorated within the rehabilitation framework, although pathological signs are still abundantly apparent in follow-up examinations. Markedly severe degrees of "vital exhaustion" and "vocational exhaustion" are also seen in rheumatology patients undergoing somatic rehabilitation. This agrees with case history details related by many female and male patients. Hence, it appears necessary to adapt rehabilitative intervention to both the psychovegetative and the medical behavioural aspects of this symptom. Scientific classification of the entire sphere of chronic fatigue in respect of rehabilitation requires classification of the relevant functions within the ICF framework. To this end it would be necessary to conduct patient inquiries within cross-sectional studies on the one hand and, on the other, a systematic consensus process among experts would have to be used for allocation to the relevant functions. This is the basis for development of suitable assessment tools for use in prospective studies in order to systematically evaluate the impact on functions and especially their effects on activities and participation.

Disability Evaluation↗
PubMed2004

[Educational objectives in the new interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Techniques" under the 9th Revision of the Licensing Regulations for Doctors--consensus recommendations of the German Society for Rehabilitative Sciences and the German Society for Physical Medicine and Rehabilitation].

In October 2003 the 9 (th) revision of the Federal Medical Training Regulations (Approbationsordnung) came into effect. The new compulsory interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" offers the opportunity to teach all students in comprehensive concepts of Rehabilitation such as the International Classification of Functioning, Disability and Health (ICF) of the WHO and the new book 9 of the German Social Code (SGB 9), as well as Physical Medicine and Naturopathic Treatment. Since the content of this new subject has not been defined up to date a joint task force of the German Society of Rehabilitation Science and the German Society of Physical Medicine and Rehabilitation was founded in order to recommend teaching standards. As part of these teaching standards educational objectives are introduced in this article. They should guide the persons in charge of teaching the subject in the medical faculties. In some areas the students should acquire profound abilities and skills in addition to knowledge. The medical faculties may focus on different educational targets according to their individual teaching profile.

Complementary Therapies↗
PubMed2002

Chronic epicondylitis: effects of real and sham acupuncture treatment: a randomised controlled patient- and examiner-blinded long-term trial.

OBJECTIVE: The clinical long-term effectiveness of real and sham acupuncture treatment on differentiated pain measurement was evaluated in chronic lateral epicondylitis, an example of a tendomyotic disorder. METHODS: Randomised, examiner- and patient-blinded controlled clinical study. OUTCOME MEASUREMENT: pain at rest, pain on movement, pain on exertion, frequency and duration of pain. Real acupuncture (n = 23) was tested versus invasive sham acupuncture (n = 22). Ten treatments were given (2 treatments/week). Patients were examined at baseline (E1) as well as 2 weeks (E2), 2 months (E3) and 1 year (E4) after the end of treatment. In the treatment with real acupuncture, acupuncture points were selected and mechanically stimulated while in the sham group non-acupuncture points were selected. RESULTS: There was no significant difference between the groups at baseline for any outcome parameter. Two weeks, 2 months and 1 year after the end of treatment there were significant reductions in all pain variables compared to baseline. At the first follow-up, significant group differences were registered for pain on motion and pain on exertion in favour to the real acupuncture group. These differences in pain intensity between the groups were no longer significant at the 2 months and 12 months follow-ups. CONCLUSION: The results suggest that, in the treatment of chronic epicondylitis, the selection of so-called real acupuncture points gives better results than invasive sham acupuncture at early follow-up. This additional effect can be interpreted as a specific effect of real acupuncture.

Acupuncture Therapy↗
PubMed2001

A follow-up study of 45 patients with elective mutism.

Forty five patients (23 boys and 22 girls) with elective mutism (8.7 +/- 3.6 years old), who were referred to a university department and a child guidance clinic within a 15-year-period, were followed up on average 12 years later. For 41 of them, sufficient information could be obtained at follow-up, and 31 patients could be investigated personally. At follow-up, an interview and a standardized psychopathological examination were carried out as well as two standardized biographic inventories. The main results were: 1) a high load of individual and family psychopathology was characteristic of the patients. The disorder started already at age 3 to 4 and referral age was 8 years on average. 2) In 16 out of 41 patients (39%), a complete remission could be observed. All other patients still revealed some communication problems. 3) The formerly mute patients described themselves as less independent, less motivated with regard to school achievement, less self-confident and less mature and healthy in comparison to a normal reference group. 4) A poor outcome could be best predicted by the variable "mutism within the core family"at the time of referral.

Age of Onset↗
PubMed2001

Circadian variations in the responsiveness of human gallbladder to sulfated mineral water.

It is well known that the intake of sulfate-containing natural mineral waters leads to contraction of the gallbladder, probably induced by the release of cholecystokinin (CCK). As early as 1959, there were some hints in the literature of circadian variations in gallbladder response; to find out whether this applies with sulfate as a stimulus, a pretest for basic information about gallbladder reaction to sulfate-containing mineral water was carried out on 19 healthy volunteers. On this basis, 15 healthy subjects of both sexes were then studied. After 6h of fasting, 500 mL of a sulfate-containing mineral water (2,800 mg SO4(2-)/L) were ingested within 5 min. The size of the gallbladder was registered ultrasonographically before and 15, 30, 60, and 120 min after drinking. The experiments were carried out seven times at different hours of the day for each volunteer. After the intake of the mineral water, the mean gallbladder size decreased significantly, followed by an increase after 60 min (P < .001). Significant circadian spontaneous variation in gallbladder size was detected (acrophase around 09:00; amplitude was 30.0% of daily average, P < .001). The contraction induced by the sulfate-containing water was most marked in the early morning hours and minimal around mid-day; the amplitude of this variation accounting for 29.0% of the daily average (P < .01). In contrast, the postdrinking relaxation was maximal around 18:00 and minimal around 9:00 (amplitude 38.5%. P < .001). These results show that the basal size of the gallbladder and its reaction to stimuli show a marked circadian variation: Whereas contractibility is maximal in the morning, dilatation is stronger in the afternoon.

Adult↗
PubMed2001

Early rehabilitation of head-neck edema after curative surgery for orofacial tumors.

OBJECTIVE: To evaluate a rehabilitative program for postoperative head-neck edema. DESIGN: Eleven patients completed the study. A series of ten manual lymphatic drainage were initiated and completed early after surgery. On discharge from the hospital, the patients wore "made-to-measure" or customized compression garments for the next several weeks. Tape measurements and sonographic evaluation of the soft-tissue width were used to quantify the extent of the swelling. RESULTS: After 6 wk of therapy, the patients exhibited a statistically significant (P < 0.05; Wilcoxon's test) remission; the remission continued in eight patients who were measured at 12+/-3 wk. CONCLUSIONS: This initial trial demonstrates that sequential therapy of manual lymphatic drainage and compression garments can significantly reduce early postoperative edema after curative surgery for orofacial tumors. The outcome can be quantified by comparing the course of distances between the defined anatomic marks and by sonographic evaluation of soft-tissue width. This pilot study encourages that more controlled, randomized studies, with larger numbers of patients, be conducted to verify these results.

Activities of Daily Living↗
PubMed2001

Credibility of a newly designed placebo needle for clinical trials in acupuncture research.

OBJECTIVE: To test the credibility of a newly designed placebo needle for acupuncture research. DESIGN: Analysis of data on credibility of true and placebo interventions of a randomised, placebo-controlled, patient- and evaluator-blind clinical trial. PATIENTS AND SETTING: The study was carried out at a university department for physical medicine and rehabilitation. 68 patients (age 48.1 +/- 14.1 years, mean +/- SD) fulfilling the criteria of the International Headache Society for tension-type headache were enrolled into the study. INTERVENTIONS: Group 1 (treatment) was assigned to traditional needle placement and manipulation, whereas in group 2 (control) a new placebo device was used. OUTCOME PARAMETERS: After the first treatment with real or placebo acupuncture, patients were asked to fill in a questionnaire on credibility. In addition, after 3 or 4 treatments, patients were asked for the feeling of needle insertion and deqi. RESULTS: No difference between real and placebo acupuncture was detected with respect to the credibility of the treatment (p > 0.05). Needle insertion was recognised in all patients in the real acupuncture group and in all but 4 patients of the placebo group (p < 0.05). deqi was reported by 84% of patients in the real acupuncture group and by 34% of patients in the placebo group (p < 0.001). CONCLUSION: Acupuncture with the placebo needle device described here is of high credibility, and does not differ from that of real acupuncture treatment. However, to achieve comparable prick sensations in both treatment conditions, careful training with the placebo needle is needed. Furthermore, from these results arise new questions with respect to the placebo response of placebo needles. Further investigations are warranted to test if placebo needles are active controls.

Acupuncture Therapy↗
PubMed2000

Circadian variations of the serum creatine kinase level--a masking effect?

Since the serum level of the enzyme creatine (phospho)kinase (CPK) is frequently used for diagnostic purposes and since circadian variations of this parameter have been observed under different stress conditions, it had to be determined whether they are induced by an endogenous circadian rhythm or whether they are activity-related masking effects. For this purpose, 15 untrained male test persons were examined for a period of 25h each under different conditions: lying constantly in a climatic chamber, everyday activity conditions, resting conditions with intermittent bicycle ergometer tests (1.4 W/kg body weight) between 09:00 and 11:30 or between 15:00 and 17:30. In addition, 5 sportsmen were included in the study under resting conditions and the bicycle ergometer tests in the forenoon. The serum CPK was determined at intervals of 2h or 4h, respectively. Under constant resting conditions, the mean serum CPK level decreased continuously (p < .001, repeated measures analysis of variance [Rep. Mes. ANOVA]), and the final values amounted to approximately 80% of the initial values. In contrast, under everyday conditions, the mean CPK level rose during the activity phase and decreased again to below the initial values during subsequent rest (p < .001, Rep. Mes. ANOVA). In the ergometer tests, the CPK blood level rose in each case after the activity phase and fell again continuously in the following resting period. However, in the calculation of the deviations from the linear trend, it was shown that certain daily variations in the CPK values can be detected under constant resting conditions; however, the amplitude was much smaller than the amplitude under everyday activity conditions. All in all, it can be stated that serum CPK levels are mainly dependent on the physical load conditions, and that the daily changes observed under everyday conditions disappear almost entirely under resting conditions. The daily variation of the serum creatine kinase level under everyday conditions can thus be regarded as a masking effect. These results are of practical significance for diagnosis to the extent that the physical activity that has taken place before the determination of the CPK level must be taken into account in the interpretation of the values. According to the results obtained so far, the CPK serum level may be used in chronobiology as an indicator of masking by physical activity.

Adult↗
PubMed1999

[Prospective study of the long-term effectiveness of inpatient rehabilitation of patients with chronic cervicobrachial syndromes and the effect of prescribing special functional pillows].

In order to investigate the long-term effect of clinical rehabilitation measures as well as the additional effect of prescription of a special pillow in patients suffering from chronic cervicobrachialgia a total of 149 patients was investigated. All patients suffered from chronic cervicobrachialgia and were admitted for rehabilitative treatment in the orthopaedic Elfenmaar-Klinik of Bad Bertrich. For a four-week period the patients were treated with physical therapy including gymnastics, electrotherapy, thermotherapy, and massage. Additionally they underwent a health-promoting programme specially designed for patients with spondylopathia. The patients were randomly divided into two groups, one receiving a special pillow (Curavario, Pala-Medic-Company) for the use during and after the rehabilitative treatment (n = 76 or n = 73, respectively). For two weeks before the treatment, during the four-week treatment period and for two weeks after the treatment the patients had to fill in a questionnaire, comprising among others six questions on the intensity of their cervicobrachialgic symptoms (pain-intensity [local pain, radiation of pain], muscular tenseness, paraesthesia and sleep disorders [caused by pain or paraesthesia]). Three, six, and nine month after the treatment period the patients received a similar questionnaire. Immediately after the treatment period a significant reduction of mean pain intensity and muscle tenseness (p < 0.001; Rep.-Mes.-ANOVA) was found. At the same time significantly lower frequencies of pain radiation and sleep disorders caused by pain or paraesthesia (p < 0.001; chi-square-test) were found. During the following nine months the intensity of the symptoms slightly re-increased, however, all parameters were still reduced nine months after treatment compared to the values before treatment (p < 0.01). Before and during the treatment no difference between the two groups could be detected, however, the follow-up showed significantly lower scores of pain intensity (p < 0.05; Student-t-test) and sleep disorders (p < 0.01; chi-square test) in the patients who had received the special pillow. It is concluded that the rehabilitative treatment is effective in patients suffering from chronic cervicobrachialgia and that the complaints in the post-treatment period can be reduced by prescription of special pillows.

Adult↗
PubMed1996

Body weight in acute anorexia nervosa and at follow-up assessed with percentiles for the body mass index: implications of a low body weight at referral.

OBJECTIVE: A systematic epidemiological comparison of body weights of patients with anorexia nervosa can be enhanced by the use of age percentiles for the body mass index. METHOD: To demonstrate the feasibility of this approach, body mass indices of 81 female adolescents with anorexia nervosa were calculated from anthropometric data upon admission for inpatient treatment and at follow-up and set into relationship to the age-dependent distribution of the body mass index in a large and representative sample of the German population. The percentiles were used to visualize the weight increase over time of each former patient by aligning the body mass index at referral with the respective body mass index at follow-up. RESULTS: Upon admission most adolescents had body mass indices below the third age centile. The distribution of body mass indices at outcome suggests a continuum between death of complications related to starvation, chronic anorexia, residual anorexia, and a low body weight Patients with very low body weights at referral had a poor prognosis, because their body weights tended to remain below the minimal normal weight for height. These conditions were statistically best described by categorical analysis, because they were nonlinear to a certain extent. DISCUSSION: The results indicate that the body mass index at referral influences the amount of weight that an individual patient gains in the future.

Adolescent↗
PubMed1996

Familial aggregation of spelling disability.

This study examined the familial aggregation of spelling disability in a sample of 32 German school-aged children and their relatives. The influence of two different diagnostic criteria (low-achievement criterion, and regression-based IQ-discrepancy criterion) on the rate of affectedness was investigated. Results revealed that 52.3-61.9% of the sibs and 26-34% of the parents were spelling disabled. Little evidence was found for an influence of the diagnostic criterion on the rate of affectedness.

Achievement↗
PubMed1996

[Effect of an oligo-antigen diet on the behavior of hyperkinetic children].

The influence of an oligoantigenic diet on different dimensions of the behavior of 21 children diagnosed as having attention-deficit hyperactivity disorder (ADHD) was examined. Treatment effects were assessed with three subjective measures (two questionnaires and an interview) and three objective measures (two attention tests and actometer). The study was divided into three phases: baseline, diet and provocation, each lasting three weeks. A crossover design was used. A significant effect was found for the subjective measures, but not for the objective measures. The results are discussed in terms of possible types of effects, e. g. rater effects and environmental effects. It may be that the oligoantigenic diet influences only certain dimensions of hyperactivity.

Attention Deficit Disorder with Hyperactivity↗
PubMed1994

[Therapeutic capacities of a university child and adolescent clinic with regional responsibilities and associated facilities].

In a clinical population of more than 10,000 children and adolescents the therapies used were analyzed statistically. The sample consisted of all children and adolescents referred to the Department of Child and Adolescent Psychiatry of the University of Marburg or one of its associated facilities between 1983 and 1991. Usage at each facility (inpatient wards, outpatient clinic, day treatment ward, mobile child psychiatric service and child guidance clinic) was analyzed separately. The facilities differed markedly regarding the age and sex distribution of the clients, diagnoses made, types of treatment used and overall duration of treatment. Furthermore, the duration and intensity of different types of treatment (psychotherapy, functional therapies, parent- and family-oriented interventions, other context-oriented interventions, pharmacological treatment) differed substantially at the different facilities. Overall a central component of treatment was work with the parents and other family members; in quantitative terms, drug treatment was of minor importance. With many patients and families a combination of two or more different types of treatment was used; therefore it is very important to integrate the different therapies into a treatment plan tailored to the individual and with consistent goals. The results are discussed in connection with quality assurance.

Adolescent↗
PubMed1994

[The value of various forms of therapy in a university child and adolescent psychiatric clinic and associated facilities. Methodological aspects and contents of therapy documentation within the scope of quality assurance].

This study is an extension of an investigation by the same authors in which the treatment provided by a university child psychiatry department and associated facilities was analyzed. First a system for the assessment of therapeutic measures for children and adolescents with psychiatric disorders and their families is presented. Then the frequency of use of the different forms of therapy in a sample of more than 10,000 referred children and adolescents is discussed. The statistical analysis was conducted separately for the different facilities (inpatient wards, outpatient clinic, day treatment ward, mobile child psychiatric service and child guidance clinic). The results show the relative importance of the different types of treatment in the field of child and adolescent psychiatry. Furthermore, they show how the frequency and intensity of use of the different treatment forms varies in the different facilities. In some treatment categories (e.g. pharmacological treatment) there are significant differences among facilities, whereas in others (e.g. parent counseling and family-oriented interventions) the rate of usage is about the same at all facilities. With regard to methodology, the question is discussed of how treatment effectiveness can be assessed and documented in a practicable and meaningful way.

Adolescent↗
PubMed1989

[The effect of mineral water containing calcium on supersaturation of urine with calcium oxalate].

The influence of mineral waters with different calcium content on the urine composition was investigated. Twelve healthy male test persons were housed for 3 x 24 h (once a week) in a climatic chamber under constant resting conditions. The standardized food intake was distributed equally over 24 h. Six 4-h urine samples were collected and chemically analyzed to study the risk of stone formation. The total amount of mineral water (Staatl. Fachingen or Bad Wildunger Helenenquelle) or of tapwater was administered in three portions (700 ml at 9.00, 350 ml at 13.00, 350 ml at 17.00). After mineral water intake, the calcium concentration in the urine was slightly higher. However, the more highly mineralized water caused a significant increase in the urinary magnesium concentration, which persisted into the night. The citrate concentration was increased as a result of alkalization of the urine. After mineral water intake the oxalate excretion was slightly (but not significantly) higher. However, no increased risk of calcium oxalate stone formation was seen when different supersaturation ratios were used as the basis of calculation. In a second study, further 12 volunteers of both sexes were given an oxalate-rich standard meal and 500 ml of the test waters in addition. The urine oxalate concentration was measured hourly for 6 h after the meal, and the total oxalate excretion was calculated. The renal oxalate excretion after mineral water intake was significantly reduced compared with tapwater controls. This effect may be caused by intestinal binding of oxalate by calcium and indicates a further lowering of the risk of calcium oxalate crystallization.

Adult↗
PubMed1987

Circadian variations of urine excretion and adrenocortical function in different states of hydration in man.

On 3 different days, the circadian rhythms of urinary volume and cortisol excretion were measured under different conditions of water supply in healthy male subjects. The water intake was systematically varied (100, 350, and 600 ml/3 hr of tap water) starting 6 hr before the beginning of the measurements, which were carried out under constant bed rest in a climatic chamber. Every 3 hr, a standardized low-protein meal was administered. The daily courses of cortisol excretion showed an increase of the mesor, which was proportional to the amount of water intake. The absolute amplitude was significantly higher when 600 ml/3 hr was taken. The circadian acrophase was shifted in advance, and the slope of the curves after the nightly minimum was significantly increased in the experiments with 350 and 600 ml/3 hr fluid intake. The urinary volume showed analogous modifications. These results are interpreted as a nonspecific activation of the adrenal cortex and a circadian variation of the sensitivity of renal regulation of the water balance.

Adrenal Cortex↗