Biomedical subjects

Max-Josef Hilz

Publications and source records attributed to Max-Josef Hilz.

4 recordsLinked to original sources

PubMed2003

Increased hypoxic blood pressure response in patients with amyotrophic lateral sclerosis.

OBJECTIVES: There is evidence of impaired cardiovascular autonomic control and reduced baroreflex sensitivity in patients with amyotrophic lateral sclerosis (ALS). A compromised baroreflex-chemoreflex interaction might result in inadequate responses to chemoreflex activation with progressive hypercapnia and hypoxia and contribute to early fatalities. This study was performed to assess cardiovascular and ventilatory responses to hypercapnic and hypoxic stimulation in ALS patients with impaired baroreflex function. PATIENTS AND METHODS: In 15 ALS patients with previously demonstrated baroreflex dysfunction and in 15 age-matched controls, we compared electrocardiographic RR-interval (RRI), systolic blood pressure (SBP) and minute ventilation (VE) during normal ventilation and during selective progressive hypoxia and hypercapnia. RESULTS: Ventilatory and RRI responses to hypoxic and hypercapnic stimulation as well as SBP responses to hypercapnia did not differ between patients and controls. In contrast, hypoxia induced a significant SBP increase in patients only. CONCLUSIONS: The normal ventilatory and RRI responses to chemoreflex activation suggest intact afferent chemoreflex function. The hypertensive response to hypoxia might be due to a compromised interaction with the baroreflex. Avoiding hypoxic episodes might reduce the risk of cardiovascular crisis in ALS patients.

Adult↗

PubMed2003

Impact of urinary incontinence after stroke: results from a prospective population-based stroke register.

AIM: The purpose of this study was to investigate, in a community-based population, the frequency of stroke-related urinary incontinence (UI) and to analyse the long-term impact of UI on prognosis and institutional care. METHODS: Included were 752 acute stroke patients admitted consecutively during a 4-year period. We evaluated the UI by using the Barthel Index during the first 7 days and at 12-months follow-up. RESULTS: During the acute stage, the proportions of patients with full UI, partial UI, and no UI were 41%, 12%, and 47%, respectively (16%, 16%, and 68% at 12-months follow-up). A total of 45% of patients with UI at 12 months were institutionalised compared with 5% of patients without UI. In a multivariate logistic regression model, age, urinary incontinence at day 7, and severe disability at 12 months were demonstrated to be independent factors for a higher frequency of institutional care 12 months after stroke. CONCLUSIONS: On admission in the acute stage, more than 50% of an unselected stroke population have UI. The proportion declines to one third of the surviving patients at 12 months. Stroke survivors who are incontinent in the acute stage have an fourfold higher risk to be institutionalised after 1 year.

Acute Disease↗

PubMed2003

Burden of care in amyotrophic lateral sclerosis.

OBJECTIVES: Amyotrophic lateral sclerosis (ALS) is a fatal disease with unique demands on patients and carers. PATIENTS AND METHODS: The total burden of care and burden components in 37 ALS carers were measured using validated questionnaires. Furthermore, influencing factors (functional impairment of the patient, additional carers, participation in support groups) were assessed. RESULTS: The mean total burden of care for ALS was low compared with dementia, mixed neuropsychiatric and internal diseases, but was correlated with functional impairment (P = 0.003). The main burden components were 'personal and social restrictions' and 'physical and emotional problems'. Problem behaviour of the patients was low in general, but was higher in carers participating in support groups (P = 0.002). Carers supported by additional carers had higher strain. CONCLUSION: The low burden of ALS carers may be caused by the low incidence of problem behaviour in ALS patients. However, if problem behaviour exists, carers participate more often in support groups, indicating the need for assistance. The burden of care increases with the functional impairment. Support for the carers has to start sooner.

Adult↗

PubMed2002

Subjective experience and coping in ALS.

OBJECTIVE: Amyotrophic lateral sclerosis is a rapidly progressive and fatal disease which has no known cure and limited symptomatic treatment. While coping strategies in more common diseases are widely assessed, coping is poorly understood in ALS. METHODS: We examined 41 ALS patients using a standardised interview, a validated coping self-rating questionnaire and a self-rating depression scale. The evaluation was repeated after six months. RESULTS: "Loss of speech", "loss of mobility" and "the poor prognosis" were the most frequent answers in the standardised interview to questions regarding the worst aspect of the disease. Pain was seldom mentioned. "Family members" were most helpful in coping with the disease, followed by "unspecific mechanisms" and "technical aids". None of our patients expressed a wish for assisted suicide. In comparison with other fatal diseases, patients with ALS had similar rankings in the coping mechanism of "rumination", but lower rankings in "search for social integration", "defence of fear", "search for information and communication". In contrast,* "search for hold in the religion" was of high importance for our ALS patients. In the follow-up examination the importance of "search for information and communication" increased. CONCLUSION: The results emphasise the importance of "loss of speech" and the importance of the caring family as well as the availability of technical aids in ALS. Coping in ALS seems to be based mainly on "rumination" and *"hold in the religion", but the increasing importance of "search for information" indicates that the sustained offer of information is essential.

Adaptation, Psychological↗