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Biomedical subjects

D Rosemeyer

Publications and source records attributed to D Rosemeyer.

18 recordsLinked to original sources
PubMed2005

[Obesity treatment in rehabilitation clinics--explanations and remarks on implementing clinical practice guideline].

This paper focuses on the improvement of obesity treatment during in-patient rehabilitation. ASSIGNMENT: The diagnosis of obesity rarely is in the foreground of assignment to rehabilitation. Obesity is the primary diagnosis in only about 1 % of all adipose patients; the term is also non-specific with respect to the causal role in the Metabolic Syndrome. The effects of obesity (diabetes, hypertension, myocardial infarction, arthrosis) are treated but not the underlying cause. THERAPY: Treatment of obesity can be the primary focus or take place as an adjunct to the treatment of other diseases; it therefore requires different structures and a sufficient number of patients. Life style change is an essential aspect of obesity-specific behavior therapy and requires closed groups. Different modular therapeutic offerings are more suitable in physiotherapy and sports. In general, 85 - 90 % of all patients meet the prerequisites for group settings (i. e., ability to communicate, discipline). A generally accepted uniform pattern of motivational assessment appears to be important to treatment success but has to be postulated as yet. Pre-assessment interviews and subjects' response to proposed therapy settings are useful means of identifying motivated patients. QUALITY: Setting down rehabilitative goals in writing facilitates patients' achieving therapeutic targets. Medical discharge summaries should reflect the process state (motivation, therapeutic modules, concomitant illnesses, target agreements, subjective and somatic changes in quality of life). Ongoing ambulatory care seems important but can rarely be implemented. Accepted indicators of the quality of rehabilitative obesity treatment need to be determined.

Ambulatory Care↗
PubMed2001

Development of an EORTC disease-specific quality of life module for use in patients with gastric cancer.

Quality of life (QL) is an important outcome in clinical trials in oncology. There is currently no valid international QL measure for gastric cancer. This paper describes the development of a QL module for gastric cancer to supplement the European Organization for Research and Treatment of Cancer (EORTC) Quality of life (QLQ-C30) questionnaire. Phases I to III of module development were conducted in the United Kingdom, France, Germany and Spain according to EORTC QL Group guidelines. Twenty relevant QL issues were generated from the literature and interviews with health professionals (n=24) and patients (n=58). This produced a 24 item provisional module. Further testing in 115 patients resulted in the QLQ-STO22, containing 22 questions, conceptualised into five scales and four single items, related to disease symptoms, treatment side-effects and emotional issues specific to gastric cancer. The use of the QLQ-C30 supplemented by the QLQ-STO22 will provide a comprehensive QL measure for international trials in gastric cancer.

Adult↗
PubMed1999

Determinants of medico-social functioning after total gastrectomy.

AIM: To describe medico-social functioning after total gastrectomy and the factors determining it. PATIENTS AND METHODS: In three medical rehabilitation centres, 173 consecutive patients (female/male = 62/111) after potentially curative total gastrectomy for gastric malignancy 206 days earlier (median, interquartile range = IQR 56-644) were evaluated for different pre- and post-operative parameters with potential influence on post-operative medico-social functioning as measured with the Edinburgh Rehabilitation Status Scale (ERSS). Parameters evaluated were: gender, age, time since operation, tumour stage, type of operation, clinical centre of admittance, haemoglobin, ferritin, albumin, presence of small bowel bacterial overgrowth, rapid oro-coecal transit, dyspepsia, early satiety, reflux, dysphagia, vomiting, a symptom based score, body mass index in health, at operation and on admission, weight loss since operation, calorie intake, bowel habits, and fat malassimilation. Independent influential factors for the ERSS were identified in a linear regression analysis. RESULTS: The median ERSS-score was 4 (IQR 2-6) on a scale from 0 (best) to 28 (worst). There was a significant difference in the ERSS-scores between the three different clinics. The ERSS-scores improved significantly with time since operation (ca. 22% per year). ERSS-scores were higher in patients with intestino-oesophageal reflux (+71%), with dyspepsia (+65%), or with dysphagia (+62%). CONCLUSION: Medico-social functioning was acceptable in this patient population. After total gastrectomy, dyspepsia, dysphagia, and intestinal reflux into the oesophagus need special attention.

Aged↗
PubMed1999

The effect of pancreatic enzyme supplementation in patients with steatorrhoea after total gastrectomy.

OBJECTIVE: To assess the influence of pancreatic enzyme supplementation on symptoms, energy intake, bowel habits, and fat malassimilation in patients after total gastrectomy. DESIGN: A prospective, double-blind, randomized, parallel, placebo-controlled, multi-centre trial. SETTING: Institutionalized patients in three gastroenterological rehabilitation clinics. PARTICIPANTS: 52 institutionalized patients with a faecal fat output > or = 14 g/day, operated on for malignant gastric disease a median of 198 days (interquartile range (IQR) 47-608) previously, and free from recurrence and/or metastasis. INTERVENTIONS: Nine sachets of pancreatic enzymes per day (each containing lipase 36,000, amylase 27,000, protease 2400 FIP (Federation International Pharmaceutique)) or identical-looking placebo were given for 14 days. MAIN OUTCOME MEASURES: Abdominal symptoms, energy intake, bowel habits and fat malassimilation. RESULTS: After treatment, patients on enzyme therapy felt better overall (P = 0.006), but no improvement of a specific symptom could be identified. During the intervention, the median kilojoule intake per kilogram body weight was 9% higher in the placebo group (170.8 (IQR 146.9-202.6)) than in the enzyme-treated group (157.0 (IQR 134.8-170.4)) (P = 0.03). Enzyme treatment did not result in a significant difference between the placebo and the enzyme-treated group regarding bowel habits or fat malassimilation. CONCLUSIONS: The effect of high-dose pancreatic enzymes supplementation on symptoms and steatorrhoea after total gastrectomy is marginal and does not justify its routine use.

Aged↗
PubMed1997

Small bowel bacterial overgrowth in patients after total gastrectomy.

The aim of this study was to elucidate the consequences of small bowel bacterial overgrowth (SBBO) after total gastrectomy. A total of 127 patients, evaluated for SBBO with a radiographically controlled H2-breath test (subgroup I, without SBBO, n = 80; subgroup II, with SBBO, n = 47) after potentially curative total gastrectomy for gastric malignancy, were uniformly evaluated. Mean time since operation was significantly shorter in subgroup II than in subgroup I [370 days, confidence interval (CI) 96-645 days, vs. 687 days, CI 397-976 days; P < 0.01]. Controlling for this difference, there were no other significant differences in symptoms and signs between the subgroups except for the medico-social functioning measured with the Edinburgh Rehabilitation Status Scale (ERSS). The mean ERSS showed significantly better medicosocial functioning in subgroup I than in subgroup II [3.7 (CI 2.2-5.2) vs. 5.1 (CI 3.0-7.0); P < 0.05]. After total gastrectomy, patients without SBBO did not differ significantly from patients with SBBO in most parameters. Medicosocial functioning was significantly poorer in the latter.

Bacteria↗
PubMed1997

Total gastrectomy: the influence of preserved duodenal transit and of pouch reconstruction on abdominal symptoms, nutrient assimilation, and medico-social functioning.

BACKGROUND/AIMS: The aim of this retrospective study was to establish whether patients with different reconstruction after total gastrectomy (duodenal bypass without pouch (subgroup Ia, n = 88); duodenal bypass with pouch (subgroup Ib, n = 27); continuous duodenal transit (subgroup II, n = 27)) differ concerning abdominal symptoms, nutrient assimilation, and medico-social functioning. METHODS: The 142 patients (49 females, 93 males; mean age 57.2 years, (95% confidence interval 55 to 59)) after potentially curative total gastrectomy for gastric malignancy 500 days earlier (mean: 95% confidence interval 334 to 666) were evaluated for abdominal symptoms, biochemical and haematological parameters, endoscopic findings, small intestinal bacterial overgrowth, oro-caecal transit time, objective signs of malassimilation, and the degree of medico-social functioning. RESULTS: There were no significant differences between the subgroups in any of the parameters examined. CONCLUSION: In this study, neither subjective nor objective patient data support preference for any single mode of the examined reconstructions after total gastrectomy. However, small patient numbers, unstandardised reconstruction procedures and a recruitment bias might influence these findings.

Analysis of Variance↗
PubMed1996

Nutrient malassimilation following total gastrectomy.

BACKGROUND: The aim of the study was to elucidate the degree and the pathophysiology of abdominal symptoms, malnutrition and malassimilation after total gastrectomy. METHODS: In 174 consecutive patients, with potentially curative total gastrectomy for gastric malignancy, subjective symptoms and objective parameters of malassimilation were evaluated. RESULTS: Abdominal symptoms were present in 86% of the patients. In spite of a high daily calorie intake (median 37.8 kcal/kg body weight) mean body mass index had been decreasing since good health. Anaemia was found in 46%, sideropenia in 31% and oesophagitis in 26%. Mean faecal fat excretion was 17.4 (1.4) g/day and mean fat malassimilation 14.8% (1.1) of the intake. A shortened small-bowel transit was measured in 21.7% of the patients, and bacterial overgrowth was present in 37.7%. CONCLUSIONS: Malassimilation post total gastrectomy seems to be multifactorial. Shortened small-bowel transit and subsequent dyssynchrony of pancreatic enzyme supply seem to be of major importance.

Adult↗
PubMed1996

[Effect of elevated head position in bed in therapy of gastroesophageal reflux].

In a randomized multicentric trial the effect of sleeping with the bed-head raised was studied in inpatients with reflux symptoms. All patients underwent an endoscopic and pH-metric examination. As a result from the diagnostic procedures three groups were formed: group 1 - refluxlike dyspepsia (endoscopic and pH-metric examination normal), group 2 - reflux disease without esophagitis (endoscopy normal, pH-metric examination abnormal), group 3 - refluxesophagitis (endoscopy abnormal). All patients were randomly assigned to either sleeping with horizontal bed-head or having the bed-head raised (15 cm). Furthermore, the patients in group 3 were put on treatment with omeprazole (20 mg twice a day) those in group 2 were treated with a procinetic drug (cisapride 30 mg). The patients in group 1 had no drug therapy. However, antacids were allowed in all patients. For a two-week-period reflux symptoms and use of antacids were registered. No difference was seen in the symptom-score or use of antacids. Also sub-group analysis (sex, age, body-mass-index, severity of esophagitis and nocturnal reflux) did not reveal any impact of sleeping with the bed-head raised on reflux symptoms or use of antacids.

Adult↗
PubMed1993

[Prognostic value of long-term pH-metry in the B-II resected stomach].

In a prospective study we investigated the clinical value of ambulatory 24-hour pH monitoring in the stomach after Billroth-II-resection. Recorded data of 10 patients with and 11 patients without ulcer recurrence after gastric resection were compared. The pH medians of the record periods "total time", "supine", "upright", "fasting" and "postprandial" were evaluated. Further the cumulative recording time of pH levels pH < 1, pH < 2, etc. was determined and compared in both groups. A pH median less than 2.8 "supine" indicated a postoperative ulcer recurrence with a sensitivity of 90% and specificity of 81%. A pH median less than 2.6 "fasting" predicted an ulcer relapse with a sensitivity of 90% and specificity of 72% (p < 0.001). In patients with ulcer recurrence pH was < 4 in more than 30% of total recording rime, pH < 5 in more than 45% and pH < 6 in more than 75% (sensitivity 90%, specificity 100%). According to these findings 24-hour pH monitoring seems to be useful for the prognostic assessment of the further course of ulcer disease after B II-surgery of the stomach. Thus pH monitoring results may be helpful in defining patient groups which may be candidates for acid reducing therapy to prevent ulcer recurrence.

Adult↗
PubMed1992

[Diagnosis of chronic pancreatitis. Studies of duodenal juice after stimulation with the secretin-ceruletide test. Decision limits and evaluation of various parameters].

187 patients were checked up over 4 years by the secretin-ceruletide test. Independently of the test results they were assigned to various disease groups on the basis of clinical assessment. 131 subjects were divided in a pilot investigation into: subjects with a healthy pancreas (n = 55); subjects with chronic pancreatitis (n = 50); subjects whose pancreatic condition could not be classified clearly (n = 26). 8 parameters were compared by univariate and multivariate statistical procedures in order to confirm or rule out the presence of chronic pancreatitis. The discriminatory power of the following parameters in duodenal fluid proved to be sufficiently high, with less than 15% frequency of misclassification: chymotrypsin (activity) and/or; lipase (activity) and/or; amylase (activity); viscosity. Under routine conditions measurement of the activity of two of these enzymes is sufficient. Their contribution to discrimination proved to be approximately equal. The diagnostic sensitivity and specificity of the parameters bicarbonate, lipase (concentration), trypsin (activity) and volume of duodenal fluid are lower. The classification rules derived from the above pilot group were confirmed by a diagnostic study under routine condition in a test group of 38 patients. Limitation to examining only volume and a maximum of 3 parameters which proved best in distinguishing between patients with chronic pancreatitis and healthy subjects, together with the omission of the first-hour samples after a secretin bolus, considerably reduced laboratory workload without altering the discriminatory power of the secretin-ceruletide test.

Adult↗
PubMed1986

[1,000 pancreolauryl tests: evaluation of sensitivity, specificity and use in clinical routine].

1115 examinations with the Pancreolauryl-Test (PLT) were carried out and assessed on 918 non-selected patients with various gastro-enterologic diseases. Depending on the severity of the exocrine insufficiency, sensitivity varied in confirmed chronic pancreatitis (n = 54). Overall sensitivity was 69%, in chronic pancreatitis with steatorrhoe 100%, and 54% in moderate insufficiency. In all patients not suffering from pancreatic diseases (n = 789) specificity was 77%. Since the PLT was frequently pathological in patients with subtotal gastrectomy (gastric resection) and active peptic lesion, specificity was also determined excluding these cases (29% of all patients without pancreatic disease). This resulted in a specificity of 86%. Gastric hyperacidity should be taken into consideration as a possible source of errors (for example, in the condition following an ulcer). Age, weight and alcohol consumption as well as diseases of the bile duct and liver, had no influence on specificity. Urine collection errors, occurring in 10% of the patients investigated, could be avoided by determination of fluorescein in the serum. Our results from a series of examinations on non-selected patients with a 6% prevalence of chronic pancreatitis indicated that PLT is likely to increase predictive value in selected application. If the oesophagus-gastro-duodenoscopy is non-pathological but the PLT gives a pathological result, further pancreatic investigative procedures should be carried out.

Adult↗
PubMed1979

[Importance of follow-up investigation in colonic carcinoma (author's transl)].

Extensive follow-up investigations were done in 1978 in 135 patients, most of whom had been operated for colo-rectal carcinoma of all stages in 1977. In 71% of the cases no or no sufficient postoperative control had been performed in the patients' own area. At the follow-up investigations 11 recurrences in the anastomosis, 10 of which were operable, 20 distant metastases, 1 simultaneous second carcinoma, 15 adenomas, partially with numerous atypical cells, 1 polyposis coli and 23 nonspecific granulomas of the anastomosis were detected. The Haemoccult test was positive in 3 of the 11 anastomotic recurrences. Only in cases of distant metastases were values of carcinoembryonic antigen clearly increased (greater than 5 ng/ml). These findings underline the necessity of intensifying the regular follow-up investigation in colo-rectal carcinoma.

Adult↗