Biomedical subjects

N Benda

Publications and source records attributed to N Benda.

At least 19 recordsLinked to original sources

PubMed2004

[Chemoembolization of hepatocellular carcinomas: which factors determine therapeutic response and survival?].

PURPOSE: To determine independent prognostic factors influencing the survival of patients with hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS: Ninety-one patients with unresectable HCC were treated with 269 repetitive TACE. The dosages of epirubicin (40-60 mg) and ethiodized oil (8-20 ml) were adjusted to tumor size and liver function. The impact of tumor size, macroscopic tumor type, tumor location, portal vein infiltration, capsular infiltration, tumor vascularization, uptake of ethiodized oil within the tumors, Child-Pugh-Class and Okuda-Stage on patient survival were evaluated by means of univariate and multivariate regression analysis. RESULTS: The following independent prognostic factors were found: tumor type (nodular vs. infiltrating, p = 0 008), tumor size (p = 0.01), Child-Pugh-Class (A vs. B; p = 0.02) and grade of tumor vascularization (p = 0.04). In 57 patients with HCC of the nodular type, the median survival time was significant longer than in 32 patients with HCC of the infiltrating type (17.0 months vs. 7.9 months; p < 0.003; 2 tumors could not be classified). The 1-, 2- and 3-year-survival rates were significantly higher in 57 patients with Okuda-Stage I disease, compared to 34 patients with Okuda-Stage II and III disease (73%, 31% and 8% vs. 23%, 6% and 4% p < 0.0001). CONCLUSIONS: Tumor type, tumor size and grade of liver cirrhosis have an independent impact on prognosis of patients with HCC treated by TACE. An appropriate selection of patients is necessary to improve patients survival.

Adult↗

PubMed2004

Estradiol and drospirenone for climacteric symptoms in postmenopausal women: a double-blind, randomized, placebo-controlled study of the safety and efficacy of three dose regimens.

METHOD: A randomized, placebo-controlled trial was conducted to evaluate the safety and efficacy of drospirenone (1, 2 or 3 mg) combined with estradiol (1 mg) in the treatment of climacteric symptoms in healthy postmenopausal women. RESULTS: The frequency of hot flushes was significantly decreased in all treatment groups (range 86-90%) in comparison to placebo (45%, p < or = 0.001) and remained suppressed at 16 weeks. Treatment with drospirenone and estradiol also decreased the intensity and severity of sweating, sleep problems, depression, nervousness, and urogenital symptoms. Most adverse events were mild or moderate, with similar rates observed in all groups. No serious adverse events or clinically significant laboratory abnormalities attributed to treatment occurred. CONCLUSION: These results demonstrate that the combinations of 1, 2, and 3 mg drospirenone with 1 mg estradiol are safe and effective for the treatment of climacteric symptoms.

Aged↗

PubMed2001

Cardiac output and central distribution of blood flow in the human fetus.

BACKGROUND: The objectives of this study were to establish reference ranges for left and right cardiac output and to investigate blood flow distribution through the foramen ovale, ductus arteriosus, and pulmonary bed in human fetuses. METHODS AND RESULTS: A prospective study was performed in 222 normal fetuses from 13 to 41 weeks of gestation with high-resolution color Doppler ultrasound. Cardiac output and ductal flow were calculated by use of vessel diameter and the time-velocity integral. Pulmonary blood flow was expressed as the difference between right cardiac output and ductal flow. Foramen ovale flow was estimated as the difference between pulmonary flow and left cardiac output. Gestational age-specific reference ranges are given for left, right, and biventricular output and volume of ductal blood flow, showing an exponential increase with gestational age. Median ratio of right to left cardiac output was 1.42 and was not associated with gestational age. Right cardiac output was 59% and left cardiac output was 41% of biventricular cardiac output. Median biventricular cardiac output was estimated to be 425 mL. min(-1). kg(-1) fetal weight. Ductal blood flow was 46%, estimated pulmonary flow was 11%, and estimated foramen ovale flow was 33% of biventricular output. CONCLUSIONS: The study establishes reference ranges for fetal cardiac output and offers insights into the central blood flow distribution in human fetuses from 13 weeks to term. There is a clear right heart dominance. The estimated ratio of pulmonary blood flow to cardiac output is higher than in fetal lamb studies.

Blood Flow Velocity↗

PubMed2001

An explicit no response instead of time-out in automated visual-field testing.

BACKGROUND: To evaluate the effect of response-acquisition technique on psychometric performance in visual-field testing, the conventional one-button yes/time-out method was compared with a two-button yes/no method for responding whether or not the stimulus was detected. There are a number of situations in which the single-button technique leads to ambiguous results. In this study, we thus expected the yes/no method to reduce tendencies towards habituation and automatic responding. Our hypothesis was that the two-button technique could reduce the rate of erroneous responses. METHODS: Luminance-difference sensitivity for bright stimuli (32') on a photopic background was evaluated at 26 locations within the central visual field (30 degrees) using a specially equalised video display unit and a modified 4/2-dB staircase strategy (six reversals, maximum-likelihood threshold estimation). Sixty-one ophthalmologically normal subjects (aged 20-30 years) were examined twice with each method. RESULTS: Mean sensitivities with the two-button yes/no method were found to be, on average, 0.13 dB above those measured with the one-button yes/time-out technique--a difference without clinical relevance. Within-subject variability did not differ between the two methods. However, the less intuitive two-button yes/no method had a slightly higher number of false responses in catch trials. CONCLUSION: Compared to the conventional one-button yes/time-out method, the two-button yes/no method in normal young subjects thus showed little difference in mean sensitivities and equivalent within-subject variabilities. Concerning our initial hypothesis, the yes/no method is of somewhat higher complexity and is not able to reduce the rate of erroneous responses. The one-button yes/time-out method fared a little better in error rate. In summary, the yes/no method is an alternative and additional possibility of response acquisition in visual-field testing, which is worthy of being tested in a clinical study with elderly subjects.

Adult↗

PubMed2001

Sensitivity and specificity of carbohydrate-deficient transferrin in drinking experiments and different patients.

Information provided by patients about the amounts of alcohol they drink may often be too subjective and therefore unreliable. Because of the possible serious consequences of interactions between alcohol and medication, reliable laboratory test markers for alcohol consumption are needed. Carbohydrate-deficient transferrin (CDT) is at present the best available objective measure of drinking behavior. During a withdrawal trial, 92 alcohol-dependent patients who had been admitted to a hospital in an ethanol-intoxicated state were monitored over the following 28 days by using the percent carbohydrate-deficient transferrin (%CDT of total transferrin) (%CDT) method. At the time of admission, 63% showed elevated %CDT levels. After a subsequent period of abstinence, a decrease in %CDT levels was apparent in four different groups of patients, whereas in two groups, comprising the greatest number of patients, normal %CDT levels were evident after 14 days of abstinence. In patients whose CDT levels were very high at study initiation, it took at least 21 to 28 days--and sometimes longer--for CDT to decrease to the radioimmunoassay (RIA) %CDT test cutoff point of 2.5. In a further study of 56 male alcohol-dependent patients, we measured liver enzyme concentrations, mean corpuscular volume (MCV), and four CDT variants on the first day of evidence of withdrawal syndrome. We found a significant correlation between results on the Munich Alcoholism Test (MALT) and MCV levels; among gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels; and among all four CDT variants. A cluster analysis yielded three clusters: (1) GGT, AST, and ALT levels; (2) MCV levels and MALT results; and (3) all CDT measurement variants. We conclude that these three clusters measure different detriments to the patient and that all available CDT variants are commensurate.

Alcohol Drinking↗

PubMed2001

30-item General Health Questionnaire in general hospitals: selecting items using a stepwise hierarchical procedure.

An attempt was made to improve the validity of the 30-item General Health Questionnaire by excluding items. This exclusion was performed by using correlations of sum-scores with an external case criterion. This hierarchical approach based on subsets of items (stepwise hierarchical variable selection) resulted in a 9-item questionnaire whose discriminating performance was significantly better than that of the original version.

Adolescent↗

PubMed2001

[Did suicidal behavior have relevance for prison suicide?].

OBJECTIVE: Suicides in correctional institutions occur more frequently than in the general population. Inmate suicide rates have been increasing in many countries during the last decades, possibly reflecting a selection of highly endangered individuals with a high prevalence of mental disorders. This study investigates all suicides in all correctional institutions of Austria during the last 25 years. METHODS: All available personal files of inmates who had committed suicide in the 29 Austrian prisons between January 1st, 1975, and December 31st, 1999, were analysed. Beside personal characteristics and circumstances of custody, information concerning psychiatric disorders and the inmate's history of suicidal behavior was included. RESULTS: 220 personal files of 250 suicides were available and included. Half of all suicides had a history of attempted suicide and 37 % had expressed suicidality. Referral to psychiatric consultants was known in 48.6 % and about 37 % received psychopharmacological treatment. Based on these frequent signs of psychiatric illness and vulnerability, possible implications of these results for psychiatric services of the correctional system to improve suicide prevention are discussed. CONCLUSIONS: Obvious signs of suicidality play an important role in vulnerability profiles for jail and prison suicides. Any signs of suicidality (st. p. attempted suicide, verbal suicide threat, self-harm) should have the consequence of further psychiatric care.

Adult↗

PubMed2001

[Society-research-diagnosis: have classification problems in psychiatry been overcome at the beginning of the new millennium?].

Although diagnostics of organic psychoses already had been quite well established at the beginning of the last century, no satisfactory results had been achieved in the field of functional psychoses. This led to a return towards the concept of "unitarian psychoses" and thus to a revival of cross-sectional diagnoses. With the development of psychopharmacological compounds the need for exact demarcation of disease grew. Around this time syndromatological classification systems that were supposed to be used internationally have been developed. In the course of the last thirty years the argument about the meaning of psychiatric diagnoses rose anew; the necessity of standardized means of psychiatric diagnoses was contrasted by the fact that there was no way of defining disease entities for clinical research. A polydiagnostic approach as well as clinical diagnose of the illness course--using single symptoms as predictors of the disease's course--could point to a solution.

Classification↗

PubMed2001

[Diagnosis and differential diagnosis of consciousness disorders from the psychiatric viewpoint].

Diagnosis and differential diagnosis of disturbance of consciousness are often difficult, especially when occurring in the course of psychiatric diseases. Apart from discord in defining the term of consciousness it is not always easy to distinguish between qualitative and quantitative alterations of the disorders. The performance of an exact interview and a thorough clinical examination allows an estimation of the degree of dimming of consciousness as well as the possible causes. Disorder of Consciousness is often found in patients carrying out substance abuse but also in the course of other psychiatric diseases such as depression, schizophrenia, personality disorders and dissociative disorders. This article is dealing with the clinical approach towards patients experiencing alterations or disturbances of consciousness and is also trying to communicate innovations in the field of psychiatric diagnostics.

Alcoholic Intoxication↗

PubMed2000

Reference ranges for two-dimensional echocardiographic examination of the fetal ductus arteriosus.

OBJECTIVES: To establish reference ranges for 2D-echocardiographic examination of the fetal ductus arteriosus and its relationship to the main pulmonary artery and the aorta. METHODS: A prospective cross-sectional echocardiographic study was performed in 222 normal fetuses from 13 to 41 weeks of gestation using high resolution/color Doppler ultrasound equipment. RESULTS: Gestational age-specific reference ranges are given for the diameter of the pulmonary valve anulus, diameter of the ductus arteriosus at its beginning, middle, and end, ductal length, ductal diameter-to-pulmonary valve anulus diameter ratio, and the spatial relationship of the ductus arteriosus to the main pulmonary artery and to the aorta. CONCLUSIONS: The presented data derived from a study group of 222 normal fetuses provide in-vivo insights into the morphology of the ductus arteriosus and its relationship to the adjacent vessels. The reference ranges may be helpful in prenatal diagnosis of cardiac malformations and abnormalities of the ductus arteriosus, such as obstruction or aneurysm from 13 to 41 weeks of gestation.

Aorta, Thoracic↗

PubMed2000

Blood flow velocity waveforms of the fetal pulmonary artery and the ductus arteriosus: reference ranges from 13 weeks to term.

OBJECTIVE: To establish reference ranges for blood flow velocity waveforms of the fetal main pulmonary artery and the ductus arteriosus during the second and third trimesters of pregnancy. METHODS: A prospective cross-sectional echocardiographic study was performed in 222 normal fetuses from 13 to 41 weeks of gestation using high resolution/color Doppler ultrasound equipment. RESULTS: Gestational age-specific reference ranges are given for peak velocity across the pulmonary valve, velocities in the ductus arteriosus, peak systolic velocity in the ductus arteriosus-to-peak velocity across the pulmonary valve ratio, ductal systolic velocity-to-diastolic velocity ratio, ductal resistance index and ductal pulsatility index. In the ductus arteriosus, increasing fetal heart rate was significantly associated with increasing end-diastolic velocity and decreasing systolic-to-diastolic ratio, decreasing resistance index, and decreasing pulsatility index. CONCLUSIONS: Based on a prospective study in more than 200 normal fetuses, the data provide gestational age specific reference ranges for blood flow velocity waveforms of the fetal pulmonary artery and the ductus arteriosus. The reference ranges may be helpful in prenatal diagnosis of cardiac malformations and ductal obstruction from 13 to 41 weeks of gestation.

Blood Flow Velocity↗

PubMed1999

[Does psychiatric comorbidity increase length of stay in medical, surgical and gynecological departments?].

Several studies from Anglo-American countries indicate that in non-psychiatric hospital departments mentally ill patients have a longer length of hospital stay than mentally well, while in Austria and Germany, until now, no studies concerning this question exist. Therefore, we investigated the influence of psychiatric comorbidity on the length of stay in 608 patients of medical, surgical and gynecological departments in Vienna and Tyrol. Based on the Clinical Interview Schedule, 28.1% of the patients in this sample suffered from psychiatric disorders. The presence of psychiatric disorders, as well as type of hospital department (medical department), higher age, more previous non-psychiatric treatment periods, and more somatic diagnoses predicted a longer duration of inpatient treatment. To avoid the influence of cofounding variables, psychiatric cases were matched with psychiatric non-cases. The mentally ill group was treated for a markedly longer period as inpatients than the mentally well. Patients with a diagnosis of dementia or of substance abuse showed a significantly increased length of stay, while we could not confirm this for other psychiatric diagnoses.

Adult↗

PubMed1999

Models for the description of angioscotomas.

To describe small scotomas in visual field examinations several statistical models are proposed and applied to the evaluation of angioscotoma in 13 ophthalmologically normal subjects. A special perimetric grid is used where thresholds can be estimated along a line of narrow-spaced test points which crosses the predicted location of the retinal vessel. A two-stage analysis employs single estimations to fit a threshold curve by means of a special parametric description of the luminance difference sensitivity threshold as a function of stimulus position. An alternative model incorporates the threshold as a function of position into the probabilistic description of the binary response (stimulus seen/not seen).

Adult↗

PubMed1999

Angioscotoma detection with fundus-oriented perimetry. A study with dark and bright stimuli of different sizes.

Fundus-oriented perimetry (FOP) was used to evaluate the effectiveness of different-sized bright and dark stimuli in detecting and quantitatively measuring angioscotoma. The foveolas and optic disks of digitized fundus images were aligned with their psychophysical counterparts to construct individual grids of perimetric stimuli. Each grid included a linear set of test point locations crossing a retinal vessel. Angioscotomas immediately became visible in nine of 13 healthy normal volunteers tested with FOP. Additional mathematical processing of local loss of differential light sensitivity (dls) disclosed an angioscotoma for at least one stimulus condition in all persons tested. The angioscomas were usually deeper for small (12) targets than for large (32') ones. On the other hand, the overall noise at dls thresholds was generally higher for small than for large stimuli regardless of whether the stimuli were bright or dark. No noteworthy differences were found in detection rates or signal-to-noise ratios under different stimulus conditions (dark/bright/small/large). FOP permits the individual arrangement of stimuli for specific morphological conditions and is thus capable of detecting even minute visual field defects such as angioscotomas.

Adult↗

PubMed1998

[Prevalence and follow-up of psychiatric diseases in internal medicine departments].

While several surveys have shown that psychiatric disorders are common in non-psychiatric hospital departments, information on the course of psychiatric morbidity during the hospital stay is still lacking. Therefore, in two medical hospital departments in Austria we investigated the course of illness in 265 patients staying in the hospital for more than four weeks. Patients were interviewed using the Clinical Interview Schedule. At admission, prevalence of all psychiatric disorders was 46.0%. During the four weeks after admission, mentally well were discharged from hospital more frequently than mentally ill. Among those staying in the hospital after four weeks, prevalence was 51.4%. In the intervening period, the incidence (9.5%) was slightly lower than the rate of remission (12.4%). At both assessments, organic mental illness was the most frequent diagnosis followed by neurotic and adjustment disorders. Thus, in spite of the slightly higher rate of remission than incidence, the overall psychiatric prevalence increased during the first four weeks after admission because of the earlier discharges of the mentally well. In conclusion, our results show that point-prevalence surveys not regarding disease course give an incomplete impression of psychiatric morbidity in non-psychiatric hospital departments.

Adjustment Disorders↗

PubMed1998

Motor skill learning in patients with cerebellar degeneration.

To explore the role of the cerebellum in learning a complex motor task, we studied nineteen patients with cerebellar degeneration and sixteen healthy subjects who attempted to improve their performance in generating a trajectory connecting five via points on a data tablet. Multijoint arm movements were performed at a constant total movement time, and spatial error was measured. Subjects performed 100 trials at a movement time of 3.5 s (slow movements), and another 100 trials at maximum speed (fast movements). With slow movements, patients and normal subjects reduced the error over trials to the same extent, but in patients, the rate of improvement was slightly slower. With fast movements, patients showed less improvement than normal subjects. When tested 24 h later, patients demonstrated significant retention of acquired skill and tended to improve more rapidly when performing both slow and fast movements than during the first session. We conclude that patients with cerebellar degeneration can exhibit almost normal performance in skill learning with slow movements, but with fast movements, their performance improves to a lesser extent. The problem may be difficulty in the refinement of motor execution, which is more of a requirement for fast movements than for slow ones.

Adult↗

PubMed1998

Prevalence and course of psychiatric disorders among nursing home admissions.

Several studies have shown that psychiatric disorders are common in nursing homes, but information on the course of psychiatric morbidity shortly after admission is still lacking. Therefore, we interviewed 262 residents of Austrian nursing homes within 2 weeks following admission, and a second time after 6 months. Using the Clinical Interview Schedule and its case criteria, prevalence was 76.3% at admission, and 69.9% 6 months later. In the intervening period, the mortality rate was markedly higher among psychiatric cases, and the incidence of new psychiatric cases (5.9%) was slightly lower than the rate of remission (8.6%). At both assessments, organic mental illness was the most frequent diagnosis. Nursing home residents suffering from psychiatric disorders were treated predominantly by general practitioners applying a psychotropic drug regimen.

Aged↗

PubMed1998

Insertion/deletion polymorphism of the angiotensin I-converting enzyme gene is associated with coronary artery plaque calcification as assessed by intravascular ultrasound.

OBJECTIVES: We evaluated the influence of the insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) gene on coronary plaque morphology and calcification in patients with angiographically documented coronary artery disease (CAD). BACKGROUND: The ACE I/D polymorphism has been associated with an increased risk of myocardial infarction in patients with the DD genotype but not with the presence of native CAD. METHODS: We studied 146 patients undergoing percutaneous transluminal coronary angioplasty for stable angina pectoris by means of preinterventional intravascular ultrasound (IVUS). Qualitative and quantitative criteria were used to classify the target lesions as poorly or highly echoreflective or as calcified. Genomic deoxyribonucleic acid was analyzed by polymerase chain reaction (PCR) to identify the I/D polymorphism, with a second insertion-specific PCR in DD genotypes to prevent mistyping. RESULTS: The ACE genotype groups (DD 46, ID 68, II 32) were well matched for the basic characteristics. Patients with the DD genotype had significantly more calcified lesions (DD 80%, ID 57%, II 66%; unadjusted odds ratio [OR] 2.88, 95% confidence interval [CI] 1.30 to 6.92, p = 0.008) and more calcifications >180 degrees of the vessel circumference (DD 22%, ID 10%, II 6%; OR 2.80, 95% CI 1.05 to 7.63, p = 0.03). The prevalence of myocardial infarction was not significantly associated with coronary calcification (OR 1.44, 95% CI 0.72 to 2.88, p = 0.31). CONCLUSIONS: Patients with CAD and the ACE DD genotype have a significantly higher incidence and greater extent of coronary lesion calcification, as determined by IVUS. This finding indicates that the ACE I/D gene polymorphism is related to the development or progression of atherosclerotic plaque calcification.

Aged↗