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Biomedical subjects

H Freyberger

Publications and source records attributed to H Freyberger.

At least 19 recordsLinked to original sources
PubMed2000

Increased levels of platelet-derived growth factor in vitreous fluid of patients with proliferative diabetic retinopathy.

UNLABELLED: It is generally accepted that growth factors play an important role in the pathogenesis of proliferative diabetic retinopathy. Since platelet-derived growth factor AB (PDGF AB) is known to be involved in many angiogenetic and proliferative processes, it was the aim of our study to elucidate the role of PDGF AB in the angiogenetic process in proliferative diabetic retinopathy. We measured PDGF AB concentrations in the vitreous of 23 patients with proliferative diabetic retinopathy, 4 of them with additional rubeosis iridis as an indicator of very high vasoproliferative activity. Control measurements were done in 19 patients without diabetic or ischemic eye diseases and also in 4 non-diabetic patients with ischemic proliferative retinopathy with rubeosis iridis. To exclude PDGF remnants in the vitreous due to vitreous bleeding we additionally measured platelet factor 4 concentrations as a stable marker of activated thrombocytes in the vitreous. RESULTS: Significantly elevated concentrations of PDGF AB were found in the vitreous of patients with proliferative diabetic retinopathy, with higher levels in individuals with additional rubeosis iridis compared to controls. However, concentrations of PDGF AB were also elevated in ischemic non-diabetic retinopathy, supporting the concept that ischemia might be a strong stimulator of growth factor production in the retina. Platelet factor 4 was not detectable in any of the vitreous samples included in the study. In summary, our results indicate that the growth factor PDGF plays an important role in the pathogenesis of proliferative diabetic retinopathy, probably in synergistic action with other growth factors like IGF I, IGF II, VEGF and TNF alpha.

Body Fluids↗
PubMed1994

[Regression of hard exudates in diabetic background retinopathy in therapy with etofibrate antilipemic agent].

BACKGROUND: The aim of this pilot study was to investigate the influence of a lipid lowering therapy with etofibrate on the progression of diabetic background retinopathy in patients with diabetes mellitus and combined hyperlipoproteinemia. In addition to the well known correlation between the duration of diabetes and the quality of blood glucose control, a correlation between diabetic microangiopathy and elevated triglyceride levels is discussed for many years. The most important pathogenic mechanisms in this respect seem to be an elevation of blood viscosity and alterations in the fibrinolytic system. Fibrinogen and triglycerides are the main determinants of plasma viscosity. As lipid lowering drugs containing fibrates and nicotinic acid are able to lower triglycerides and fibrinogen effectively, a favourable therapeutic effect on the progression of diabetic retinopathy may be expected. PATIENTS AND METHOD: 11 type II diabetics with combined hyperlipoproteinemia (Fredrickson type IIb) and mild to moderate background retinopathy detected by fundus photography were treated with etofibrate (2 x 500 mg/day) for a period of 6 months. RESULTS: In 7 of 10 patients hard exudates, which had been present at the beginning of treatment, showed clear regression at the end of the treatment period. Among the laboratory test parameters a significant 30% reduction of triglycerides (p < 0.010) was observed. There was also a clear 25% increase in HDL cholesterol and a 12% fibrinogen reduction. Considerable changes of the quality of blood glucose control were not evident during the treatment period. CONCLUSION: Treatment with the lipid lowering drug etofibrate seems to produce favourable therapeutic effects on hard exudates in diabetic background retinopathy in patients with diabetes mellitus and combined hyperlipoproteinemia. The mechanisms of this effect are not yet clearly understood, in addition to positive effects on the microcirculation of the retina by lowering blood viscosity there is a direct lipolytic effect in the area of hard exudates to be discussed, too. It is important to point out that we did not see any positive effect of etofibrate therapy concerning other morphological changes of diabetic background retinopathy, i.e. microaneurysms or hemorrhages in our pilot study.

Adult↗
PubMed1994

Supportive psychotherapy.

By way of introduction the concepts 'helpful-supportive' (in analytical psychotherapy) and 'exclusive-supportive' psychotherapy are defined. Then the indications and the patients' characteristics (marked ego weakness, dependency wishes) concerning exclusive-supportive psychotherapy in psychosomatic medicine are outlined. After this we describe the three interview and treatment steps of supportive psychotherapy in psychosomatic patients which particularly include the patients' motivation for conflict-enlightenment psychotherapy. Furthermore some effectiveness criteria are presented. Apart from this motivation work, there exists an indication for supportive long-term psychotherapy in psychosomatic patients. Exclusive-supportive psychotherapy in chronically medically ill patients is founded upon the instability of the psychic adaptation processes (particularly the labilized denial work) following the manifestation of chronic disease. The characteristic intervention techniques deal with the patient's secondary frustration-aggression following, on the one hand, his idea 'Why am I so ill and not the others'. On the other hand, supportive-psychotherapeutic handling of the patient's acute or long-lasting handling of the patient's acute or long-lasting conflict situations prevails. Additional systemic psychotherapeutic procedures are highly recommended in psychosomatic and chronically ill patients, for these procedures are well suited to promoting the effectiveness of individual supportive psychotherapy.

Dependency, Psychological↗
PubMed1993

Vitreous levels of the insulin-like growth factors I and II, and the insulin-like growth factor binding proteins 2 and 3, increase in neovascular eye disease. Studies in nondiabetic and diabetic subjects.

Retinal capillary nonperfusion results in neovascularization of the eye, which is restricted to the retina in less severe cases and progresses to the anterior chamber and the iris angle in the most advanced case, called rubeosis. This angioneogenesis may be induced by the release of retinal growth factors into the vitreous. This study compared levels of the IGF-I and IGF-II, and of the IGF binding protein-2 (IGFBP-2) and IGFBP-3 in vitreous from three groups with different degrees of retinal ischemia, as judged by the extent of neovascularization: a control group without new vessel formation, retinal neovascularization in patients with proliferative diabetic retinopathy, and massive ischemia of various causes resulting in rubeosis. IGF-I and IGFBP-3 were increased 10- and 13-fold in rubeosis (P << 0.01) compared with no ischemia (n = 10), while IGF-II and IGFBP-2 were elevated 2.7- and 4.3-fold (P < 0.01). Within the rubeosis group similar changes were observed independently of the cause of ischemia, which was central vein occlusion, ischemic ophthalmopathy, or intraocular tumor in seven cases and diabetic retinopathy in three samples from two patients. Vitreous from patients with proliferative diabetic retinopathy but without rubeosis (n = 16) contained 2.5- and 2.2-fold elevated levels of IGF-I and of IGFBP-2 (P < 0.05), while IGF-II and IGFBP-3 were increased 1.4- and 1.6-fold, which was not significant. We conclude that: (a) ischemia appears to be a strong stimulus for the local production of IGF-I and -II and of IGFBP-2 and -3 in the eye. (b) Changes in IGF-I and IGFBP-2 in proliferative diabetic retinopathy may be secondary to local ischemia rather than being specific for diabetic retinopathy. (c) IGF-I and IGFBP-3 may play a role in mediating angioneogenesis in the eye.

Carrier Proteins↗
PubMed1991

Therapy outcome of two treatment models for bulimia nervosa: preliminary results of a controlled study.

Beyond the reduction of the core symptoms, different modification patterns are expected due to differing emphases in two alternative types of treatment for bulimia nervosa: inpatient analytic and outpatient systemic therapy. The initial results of a study with a waiting-list control group are reported. Eating disorders of the bulimic women definitely improved in both therapy groups, the results for the inpatient group (n = 27) indicate a basic change in the attitude towards eating.

Adult↗
PubMed1990

[Inhalation therapy with selective beta 2-sympathomimetic drugs. Effect of pirbuterol administered via the Autohaler and salbutamol administered via the Diskhaler in obstructive respiratory tract disease].

The therapeutic success of salbutamol inhalation with the powder inhalator (Diskhaler) and of pirbuterol with an inhalation-triggered metered aerosol (Autohaler) was determined by comparing the degrees of bronchodilation in 13 patients suffering from chronic obstructive airways disease. Rt and IGV were determined by whole-body plethysmography and FEV1, peak flow and MEF50 by spirometry, and pulse rates were also measured. On average, Rt values decreased by 40 per cent; the other lung function parameters responded correspondingly. Duration of action extended to 4 hours after dosage. Pulse rates and lung functions measured after administration of the products did not differ, either. In such studies as this, whole-body plethysmographic results are superior to those obtained by spirometry.

Adult↗
PubMed1990

Quality of life in patients with inflammatory bowel disease.

The term 'quality of life' is defined as the result of objective circumstances of life and subjective perceptions of patients. Health-related quality of life is a dynamic concept which changes during an adaptational process interacting with illness condition during the course of chronic inflammatory bowel disease. In a review on the research in this field, it is shown that quality-of-life assessment may be an important adjunct to the evaluation and treatment of patients with inflammatory bowel disease. The comparative evaluation of quality of life in patients treated medically and surgically may offer important information for decision making.

Humans↗
PubMed1987

Follow-up results from a psychosomatic outpatient clinic.

On the background of the German situation of psychosomatic medicine as an independent department beside the psychiatric clinic, we describe the theoretical issues, organizational structure and functioning of a psychosomatic outpatient clinic. 186 consecutive referrals were analyzed. The ratio of man to woman was 1:2, mean age was 32 years (range 17-58). About half of the patients suffered from psychogenic disorders (according DSM-III criteria subsumed to the category of 'psychological factors affecting physical condition'), 21% had anxiety disturbances, and of the remaining patients 15% had affective illnesses and 13% somatoform disorders. There were three treatment conditions: inpatient psychotherapy, outpatient individual or group psychotherapy and family therapy. Follow-up results (2 years after the first contact) give some hints on the effectiveness of the different treatment procedures. The results show that the psychosomatic outpatient clinic may offer treatment for a specific patient population whose characteristics differ significantly from those of patients treated in consultation liaison services as well as by practicing psychotherapists.

Adult↗
PubMed1986

[Secret self mutilation, a psychosomatic disease].

The present article contains initial results form systematic psychoanalytic work with patients practicing secret self-mutilation (our term for these is "mimicry patients"). The group we examined was treated on an in-patient basis in a hospital for psychosomatic disorders. The article may be considered as a preliminary report. Up until now the international range of experience is rather limited. We have therefore, made use of this occasion also for developing an applicable clinical definition of the different forms of self-mutilation. This definition is based upon psychological criteria rather than, as has hitherto been the custom, upon the techniques and the morphology of the self-inflicted injuries. Clandestine self-mutilation, in our understanding, is a psychosomatic illness. The self-manipulation has the character of a psychosomatic symptom which, although self-inflicted, is beyond the control of the afflicted individual and is accompanied by extremely reduced consciousness. So far, the experience gained in therapy points to a variety of subconscious conflicts at the back of this symptom, most frequently a severe guilt problem which is not only manifest intrapsychically but also within the family milieu of the patient. On the whole therapeutic results correspond to those observed with other grave psychosomatic disorders accompanied by organic lesions, that is to say improvement sets in slowly after a therapy extending over periods of several months to several years. Initially, a long time before any treatment of the subconscious conflict may be attempted, such therapy must employ supportive ego-consolidating methods and establish a therapeutic alliance. Even so we see no reason for resignation with regard to therapeutic success.

Adult↗
PubMed1985

The Hannover Consultation Liaison model: some empirical findings.

Starting from the definitions concerning the concepts 'Liaison medicine' and 'Consultative Psychiatry' we begin with remarks with regard to the Consultation Liaison-Situation in West Germany on the basis of the key-words 'Brief history', 'Independent university units with regard to Psychotherapy and Psychosomatics as well as the connected organization' and 'Teaching procedures'. Following it the Hannover Consultation Liaison model is presented particularly with regard to both the psychosomatic inpatient ward including the functional organization and psychotherapeutic processes as well as the so-called 'Innere Ambulanz' which includes the consultation liaison services in the clinico-medical departments outside Psychiatry and Psychosomatics. Within the 'Innere Ambulanz', which is closely connected to our psychosomatic inpatient ward, the consultation liaison activities and the resulting supportive psychotherapeutic strategies are performed by student auxiliary therapists who are interested in completing their 4-5 months internship-time in our department. We describe both the three supportive psychotherapeutic steps, which may last months to years including subsequent dynamically psychotherapeutic strategies as well as the reactions of the auxiliary therapist function on the students. Furthermore, we may state that there exists no one more optional education procedure of graduate students than the student's confrontation with his partial self-responsibility vis-à-vis a patient who is being supportive-psychotherapeutically treated by him. Specific empirical proofs concerning our patient oriented consultation liaison activities are demonstrated on the basis of previous psychotherapeutic findings in Crohn patients. Here we are able to demonstrate the effectivity of psychotherapy in the case of the supplementarily psychotherapeutically treated patients in comparison to the patients who received medical therapy only. Finally we are able to present quantitative clinico-medical inpatient needs with regard to consultation liaison activities starting from our 'Innere Ambulanz'. On the basis of our conservative estimate, 31-42% of patients showed severe psychosomatic or psychic symptoms who should be treated by psychological means in addition to the medical treatment.

Anxiety Disorders↗
PubMed1985

Psychotherapeutic interventions in alexithymic patients. With special regard to ulcerative colitis and Crohn patients.

Starting from the psychosomatic patients in clinico-medical wards and the inherent two primary alexithymic features "highly limited introspective capacity' and "very low motivation concerning dynamic psychotherapy', which we proved empirically, we describe the therapist's attitude and the three steps of supportive psychotherapy which initially represent the most indicated procedure in this patient group. In Hannover, this supportive psychotherapeutic procedure is applied by student auxiliary therapists. On the basis of our empirical findings, the effectivity of supportive psychotherapy, accomplished by students, in the alexithymic psychosomatic clinico-medical inpatients could be clearly demonstrated. Furthermore, we comment on some previous psychotherapeutic findings with regard to Crohn patients. Starting from our pretreatment and our follow-up measurements, we were able to prove that patients who were treated by both supportive psychotherapy and psychoanalytically orientated inpatient ward psychotherapy, showed remarkable improvements at all levels of the measurement techniques. Finally, we outline some clinico-psychosomatic aspects with regard to secondary alexithymia.

Affective Symptoms↗