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Biomedical subjects

J Haffner

Publications and source records attributed to J Haffner.

At least 19 recordsLinked to original sources

[Long-term course of dyslexia beyond the school years: catamnesis from pediatric psychiatric ambulatory care].

In our follow-up study 12 years after index admission we were able to examine 59 out of 115 male patients who had been diagnosed in our department as dyslexic (mean age: 10.1 years). Spelling skills at follow-up were more than one standard deviation below the norm for the subjects' age (T-value on the RT of only 24). About half of our patients had participated in a specific spelling remediation program lasting more than 6 months, but at follow-up no effect of therapy could be demonstrated. The patients with the higher IQs regressed in spelling less than those with the lower IQs. We assume that the effects of remediation programs do not survive therapy and school for long because later on good spelling is no longer either required or encouraged. Our patients were severely impaired in their school career: Although their average IQ was 112 only 6 out of 59 had completed a college-preparatory program (Abitur), all of them from middle-class families with well-educated parents. Our patients chose occupations corresponding to the type of high school diploma they had, often those requiring practical skills rather than reading or spelling skills. Patients who had completed no more than the nine obligatory years at school were less content with their work than expected. Emotional disorders during the past 6 months were no more frequent than expected. In a self-report about delinquency there was no difference compared to a random sample.

Adolescent

[Experiences with the revisions of the classification systems for psychiatric disorders (ICD-10 and Axis 5 MAS)].

In our study clinical experiences in 1990 and 1991 with the new installed ICD-10 and the new version of the fifth axis of the MAS for registering abnormal psychosocial conditions are presented. The strictly descriptive proceeding of these two new systems meets problems of acceptance in a department, whose tradition emphasizes strongly the importance of individually etiological relevant factors in the "Biographische Anamnese" for the psychiatric diagnosis.

Adolescent

[Determinants and educational approaches to AIDS anxiety in adolescents].

On the basis of a questionnaire filled out by 480 adolescents determinants of fear of AIDS were evaluated with a model of linear structural equations. The main factors that appeared were knowledge about AIDS (those who know more report less fear), personal involvement (those who are confronted more with the problem of AIDS report more fear) and sexual experience (those who are sexually more experienced report less fear). The last finding is interpreted to the effect that mainly sexually inexperienced adolescents, who are usually also the younger ones, shift their sexual fears to the AIDS-complex.

Acquired Immunodeficiency Syndrome

[Surgical treatment of necrotizing fasciitis].

We present nine patients with necrotizing fasciitis. Two of them had Fourniers gangrene. Predisposing factors included diabetes mellitus, alcohol and drug abuse. Local signs were redness, swelling and pain rapidly followed by fever and deterioration in the patient's general condition. Soft tissue-gas was observed in all patients. It was found either clinically, on roentgenograms or by CT. Bacteria were found in blood cultures and/or necrotic tissues in all patients. The dominating treatment was radical surgical excision and early reexplorations. Antibiotics, intensive care support and early parenteral nutrition were given. Four patients were given hyperbaric oxygen treatment. The overall mortality rate was 11%. Amputation of one lower extremity became necessary in three patients. In these cases 4-8 days had elapsed between the onset and the first surgical excision. We find it important to underline early diagnosis and radical surgical excision in patients with necrotizing fasciitis.

Adult

[Can surgeons be in charge of an obstetric department?].

At Rana sykehus there are neither obstetricians nor pediatricians. The obstetric ward is run by the surgeons. Pregnant women suspected of being at increased risks are transferred to Nordland Sentralsykehus before the expected delivery. The following data were obtained by analyzing 1,009 deliveries. 19.2% of all the deliveries needed emergency assistance by a doctor. Emergency cesarean section was performed in 6.2% of the cases, and vacuum extraction was needed in 3.2%. Elective cesarean section was done in 4.9% of all births. Emergency and elective cesarean section together made up 11.1% of the 1009 deliveries. The cesarean section rates were lower than the average number in Nordland and in the country as a whole. The perinatal death rate was lower than the average rate for the rest of the country (0.49% versus 0.8%). Infants with potential dangerous conditions were transferred for pediatric care at Nordland Sentralsykehus (3.96%). Our conclusion is that general surgeons can be responsible for an obstetric ward, when it is done voluntary, and it is approved by a responsible obstetrician. In our area there is a need for an obstetric ward, and the surgeons here have built a certain expertise in obstetrics. In difficult cases, however, the surgeons always consult the obstetricians and pediatricians at Nordland Sentralsykehus for evaluation of the patients.

Critical Care

[Puerperal inversion of the uterus].

Inversion of the uterus is a rare but very serious complication of childbirth. We present a case-report from a hospital with 350 to 400 births a year where since we have no gynecologist, the surgeons are in charge of obstetrics. The patient was successfully operated after an attempt to replace the inverted uterus had failed.

Adult

Serotonin--a possible transmitter for the gastric adaptive relaxation. Interaction with histamine and prostaglandin F2 alpha on pressure responses in the isolated stomach.

Serotonin, or 5-hydroxytryptamine (5-HT), relaxes upper guinea pig stomach, and its possible role as a transmitter in the vagally induced upper gastric adaptive relaxation has been discussed. Such a transmitter is expected to act via other mechanisms than crude muscle depression. To test whether the relaxation response to serotonin is compatible with a putative role as transmitter in gastric adaptive relaxation, we wanted to evaluate whether serotonin acts by crude muscle depression and whether it selectively inhibits histamine or prostaglandin F2 alpha (PGF2 alpha). The study shows that 5-HT, in addition to its relaxatory effect on fundic spontaneous activity, selectively inhibits histamine, whereas PGF2 alpha is not inhibited. It is then concluded that the relaxatory effect of 5-HT is provided through other mechanisms than crude muscle depression and that selective inhibition of intramural agonists, like histamine, is a possible effect mechanism.

Animals

Primary treatment of carcinoma of the anus by combined radiotherapy and chemotherapy.

Twenty-four patients with carcinoma of the anus were treated with a combined regimen of external irradiation (50 Gy) and mitomycin C and 5-fluorouracil. A relatively large number of patients with locally advanced disease were included. A local complete response rate of 87.5% was obtained. The major acute toxicity was dermatitis/mucositis, necessitating a split course in 14 cases. After treatment four patients had persistent anal incontinence. After an observation period of 40-70 months 14 of the patients were alive without disease. We conclude that the conservative combined radiotherapy/chemotherapy regimen is an effective treatment also of advanced anal carcinoma, with tolerable toxicity and with promising survival results.

Adult

Colo-recto-anal intussusception. Case report.

Two cases of colo-recto-anal intussusception are reported, both in old women and with a tumour at the apex of the intussusception. Primary resection of the sigmoid colon with terminal sigmoidostomy was successful in one case. Resection with anastomosis in the other case was followed by anastomotic leakage with peritonitis, requiring revisional closure of the rectum and terminal sigmoidostomy.

Aged

Determination of the optimum period of interview for retrospective collection of data. An empirical study based on reported and documented outpatient contacts of depressive patients.

On the basis of reported and documented data on outpatient contacts of depressive patients, the reliability of data on the use of services, and the possibilities and sources of errors in the retrospective collection of data are presented and discussed. The results show an increase in errors the longer the period of inquiry is removed from the time of interview. The retrospective collection of data about ambulatory care more than 6 months ago has to be questioned from a reliability point of view. The correct dating of outpatient contacts succeeds substantially more reliably when questioned about periods of 3 months than about monthly periods, which leads to implications for the definition of patterns of care.

Ambulatory Care Facilities

The immediate effect of human renal transplantation on basal and meal-stimulated levels of gastrointestinal hormones.

Elevated serum levels of gastrin, pancreatic polypeptide, and glucagon were found in 10 uraemic patients, whereas gastric inhibitory polypeptide and somatostatin levels were normal. After renal transplantation there was a significant reduction in serum gastrin (median, 5 pmol/l; p = 0.05, n = 9), pancreatic polypeptide (145 pmol/l; p less than 0.01, n = 9), GIP (9.5 pmol/l; p = 0.02, n = 7), and glucagon (92 pg/l; p less than 0.02, n = 9), whereas no alteration was seen in the somatostatin level. Meal stimulation produced consistent increases in serum levels of all hormones, and the response appeared to be unchanged after renal transplantation.

Adult

Beta-adrenoceptor blockade in the treatment of postoperative adynamic ileus.

Abdominal trauma, such as surgery and peritonitis, leads to inhibition of intestinal motility, partly mediated by alpha- and beta-adrenoceptors. To investigate the effect of nonselective beta-blockade on adynamic ileus, propranolol was compared with placebo in the postoperative course after elective colonic surgery in a double-blind randomized study. Ten patients received 4 mg propranolol intravenously twice daily, and ten received 10 mg intravenously twice daily. Nineteen patients received placebo. The time to first passage of stool was 110 +/- 9 h in the placebo group and 82 +/- 11 h in the 4-mg propranolol group. In the 10-mg propranolol group, the time was 79 +/- 8 h. The difference between the placebo-treated group and the propranolol-treated groups was significant (p less than 0.01). The effect of propranolol was most marked in older patients and after surgery on the distal colon. In patients older than 60 years the time to first stool in the placebo group was 127 +/- 13 h (n = 8), compared with 73 +/- 8 h (n = 11) in the propranolol group (p less than 0.01). In patients who had undergone surgery on the distal colon the time to first stool was 125 +/- 13 h (n = 8) in the placebo group and 76 +/- 8 h (n = 11) for propranolol (p less than 0.01). Adverse effects on the respiratory or cardiovascular system were not seen during medication. It is concluded that propranolol shortens the period of adynamic ileus after colonic surgery.

Adult

The effect of ranitidine on oesophageal motility.

Ranitidine is used to treat symptomatic oesophageal reflux; its effect is probably to a great extent due to reduced gastric secretion. Whether it also affects oesophageal motility is a matter of controversy. In a randomized double-blind study oesophageal motility was recorded in 21 healthy individuals after 3 doses of 150 mg ranitidine or placebo given over 36 h. Ranitidine increased the pressure in the lower oesophageal sphincter from 14 to 18 mmHg (p = 0.05) but otherwise did not influence oesophageal motility.

Administration, Oral