PubMed Health⌕ Search

Biomedical subjects

R Gladisch

Publications and source records attributed to R Gladisch.

At least 19 recordsLinked to original sources
PubMed2005

[Dysphagia after taking an acetaminophen-tablet during oral anticoagulation].

The bezoar is only one example for an urgent indication for endoscopic intervention during oral anticoagulation. Because of the lack of life-threatening indication the endoscopy often is delayed for 1 to 3 days until the International Normalized Ratio (INR) is nearly in normal range. As well as the application of unique guidelines on endoscopy during oral anticoagulation new future oral anticoagulants with lower half-life may help to shorten suffering of patients.

Acetaminophen↗
PubMed2005

[Atrial fibrillation and thromboprophylaxis in elderly patients].

Chronic, nonvalvular atrial fibrillation occurs more frequently with increasing age, together with an increasing risk for ischemic stroke. Guidelines recommend oral anticoagulation with a vitamin K antagonist for patients >65 years without risk factors and patients <65 years with risk factors for cardiac diseases. Advancing age also increases the risk for bleeding complications under oral anticoagulants; thus, only a part of these patients receives anticoagulant therapy. The risk of falls in elderly patients is of advancing relevance for this therapeutic decision. Oral direct thrombin inhibitors like ximelagatran may be an alternative choice for therapy. Ischemic strokes and systemic embolism in the same frequency with 2x36 mg ximelagatran over 18 months (91/3664 patients: 1.6%/year, for study Sportif III and Sportif V) compared with warfarin (93/3665 patients: 1.6%/year for study Sportif III and Sportif V). All bleeding complications occurred less frequently under therapy with ximelagatran. This could be of importance for elderly patients with risk factors for bleeding or risk of falling.

Administration, Oral↗
PubMed2004

[Recommendations for statin therapy in the elderly].

Elderly patients are significantly less likely to receive statins than younger patients possibly because of doubts regarding compliance or concerns regarding the increased likelihood of adverse events and drug interactions. Poor compliance can be expected especially in patients suffering from dementia or depression as well as those whose stage of cardiovascular disease exhibits few symptoms. On the other hand, the clinical significance of CHD events is high in the elderly, and 80% of coronary deaths occur in patients aged over 65 years. The average statistical life expectancy of elderly and old patients is often underestimated. The HPS and PROSPER studies showed that statins reduce mortality and morbidity even in very elderly individuals with a high global cardiovascular risk and/or CAD. Patients up to the age of 79 years should be treated according to the same guidelines as younger patients. Statin therapy should only be considered for patients aged 80 years and older who are at a very high risk for cardiovascular events.

Aged↗
PubMed2003

[Pharmacotherapy of elderly patients from the clinical viewpoint].

Due to increasing incidence of chronic diseases with advancing age, drugs are predominantly prescribed to elderly patients. But there is a lack of data, representing this age group. As the aging organism shows various physiologic changes that may influence pharmacokinetic parameters, an individualized risk-benefit-analysis is warranted. Moreover, functional limitations may bare additional risks of pharmacotherapy promoting adverse drug reactions. Frequent adverse drug reactions in the elderly are falls, delirium and anticholinergic symptoms. An assessment of potential hazards of pharmacotherapy is therefore essential. It should include physiologic parameters, in particular renal function, possible functional limitations and parameters of compliance. Furthermore a prudent clinical monitoring of drug therapy can limit adverse drug reactions and polypharmacotherapy due to a prescribing cascade.

Aged↗
PubMed2003

[Desire for death-results of a pilot study with acute geriatric patients].

Desire for death when expressed by patients is extremely demanding to the geriatric team. In an acute geriatric setting with its high proportion of multi morbid patients, decisions about diagnostic and therapeutic measures as well as decisions about restrictions of therapy have vital consequences. In this context, what is the significance of expressions of desire for death? A growing amount of literature has reported about studies on such questions with terminally ill patients. Studies in the field of acute geriatrics are still missing. In the present explorative pilot study, data of ten patients in an acute geriatric setting were collected within a two-month period. Data comprise various dimensions of the expressions of desire for death, and variables of their medical psychiatric, psychological, and psycho-social context. The dimensions of duration, intensity, and concreteness could be differentiated within the expressions of desire for death. In addition, they were each correlated to different context variables. Intensity was associated with experiences of pain. Subjective well-being and social support were relevant to concreteness. Duration was correlated with depression, hopelessness, experienced stress, and functional health. Physical health did not play a significant role. This means that expressions of desire for death do not only occur in the context of extreme health problems. The study has identified differentiated starting points for better understanding the expressions of desire for death and for better intervention. Further study is necessary to confirm these findings within a longitudinal design.

Acute Disease↗
PubMed2003

Is kidney size a useful predictor of renal function in the elderly?

UNLABELLED: Despite its widespread use, the diagnostic yield of ultrasonography to detect early stages of reduced renal function in the elderly remains doubtful. METHOD: Sixty-two patients (age: 74.8 +/- 6.7 years, 30 females) attending a geriatric ward were examined. Non-insulin-dependent diabetes was present in 28 patients and 32 were hypertensive. Exclusion criteria were previously known renal failure, an elevated serum creatinine above 2 mg/dl at admission or apparent cognitive impairment. Inulin clearance (C(IN)), Cockcroft estimation and urinary albumin excretion rate (UAER) were determined. Renal parenchymal volume, renal volume and mean renal length were calculated using data obtained by ultrasonography. RESULTS: A multiple regression analysis identified C(IN) as the main determining factor on renal parenchymal volume (beta = 0.360; p = 0.004). Body height showed additional influence (beta = 0.295; p = 0.018), but age, gender, diabetes, UAER and hypertension did not. Cockcroft estimation, ultrasonographic markers of renal size and further confounding variables were evaluated in a subsequent multiple regression analysis. Cockcroft estimation explained the major part of the variance (beta = 0.783; p < 0.001) and the occurrence of diabetes showed a borderline additional effect. But there was no supplementary influence of any ultrasonographic parameter. In 11 patients, C(IN) was reduced to < or = 60 ml/min. ROC analysis revealed poor diagnostic efficacy of all ultrasonographic parameters (AUC < 0.7336) compared to Cockcroft estimation (AUC = 0.8718). CONCLUSION: Although a linear relation between C(IN) and renal parenchymal volume could be shown, ultrasonography cannot replace or complement Cockcroft estimation in order to detect early reduced renal function in the elderly. Nevertheless, reduced renal parenchymal volume may occur prior to elevation of serum creatinine in the elderly and should be noted carefully on routine ultrasonographic examinations.

Aged↗
PubMed1998

Evaluation and validation of a Crohn's disease inflammatory activity index reflecting pattern of endoscopic severity.

BACKGROUND: This study was designed to investigate objective variables assessing the inflammatory activity of Crohn's disease accessible for routine management and their suitability to act as surrogate indicators for endoscopic alterations. METHODS: Thirty-six patients were included in a prospective study and underwent endoscopic investigation, 18 with clinically exacerbated disease and 18 after acute-phase conservative therapy. The endoscopic findings were classified to define the dependent variable, yielding two categoric levels: acute active disease and remission. The extent of affected mucosal area was not taken into consideration. The serum variables alpha1-antitrypsin, acid alpha1-glycoprotein (AGP), C-reactive protein (CRP), sialic acids, prealbumin (PAB), and albumin were used as independent variables to predict the dependent variable. To compare the results with common indices, the Crohn's Disease Activity Index (CDAI) and van Hees Index were calculated. RESULTS: The following model was calculated by stepwise logistic regression analysis: if AGP (mg/dl) -4.2 x PAB (mg/dl) > or =0.8, then endoscopically active disease will be predicted with a sensitivity of 100% and a specificity of 95% (P < 0.001). The predictive values of the single variables, CDAI, and van Hees Index were lower. For validation of results an analogous study was performed including 44 patients, 29 with active disease and 15 controls. The existence of the model was confirmed, again showing high values for sensitivity (86%) and specificity (100%). CONCLUSIONS: On a qualitative level focusing on clinical relevance, the endoscopic and biologic findings of Crohn's disease are highly associated. In addition to clinical assessment, usage of the developed index as a rationale contributing to therapeutic decisions in the short- and long-term management might be reasonable.

Biomarkers↗
PubMed1993

Effects of ornithine aspartate on plasma ammonia and plasma amino acids in patients with cirrhosis. A double-blind, randomized study using a four-fold crossover design.

This paper documents dose-dependent effects of ornithine aspartate (OA) on postprandial hyperammonemia and plasma amino acids. Ten patients with cirrhosis were randomized to undergo 1 out of 4 infusion series. Each series consisted of four 8-h infusions (09:00 h-17:00 h), with placebo (NaCl), 5 g, 20 g or 40 g of OA being administered on separate days in varying sequences. This 4-fold crossover design was double-blind. On infusion days, patients received 2 oral protein loads (0.25 g/kg at 09:00 h and 0.5 g/kg at 13:00 h). Venous blood samples were drawn every 2 h and the 24-h urine was collected. In addition to measuring plasma ammonia and amino acids, the urea production rate, serum glucose and serum insulin were analyzed. A significant postprandial rise in the ammonia concentration was noted during the infusions of placebo and 5 g of OA but did not occur with the dosages of 20 g (after the second protein load) and 40 g (after both protein loads). Furthermore, the latter dose, compared with placebo, significantly reduced plasma ammonia after the minor protein load. Urea production rate increased when 20 g or 40 g of OA was administered. Of the amino acids involved in the metabolic pathways of ornithine and/or aspartate, glutamate showed a rise in its plasma level following infusion of 40 g of OA, whereas glutamine did not. Concentrations of methionine, phenylalanine, tyrosine, threonine, serine and glycine declined progressively with increasing doses of OA (5-40 g). The highest dose of the drug caused hyperglycemia and hyperinsulinemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Introduction to ultrasonographic diagnosis].

The basic theory of diagnostic ultrasonography is presented. After explanation of the underlying physical principles and the A- and B-scan mode, ultrasound devices, as used in abdominal sonography (electronic parallel scanner, mechanical and electronic sector scanner), are presented. Numerous possible artefacts are illustrated. Potential side effects of diagnostic ultrasonography are considered and the examination procedure is explained.

Animals↗
PubMed1993

[Psychodiagnostic follow-up of patients with Crohn disease during intensive internal medicine treatment].

The present study includes 40 patients with Crohn's disease who underwent an internal and psychodiagnostic examination over a period of 5 to 8 weeks. On the average, there were only minor psychic symptoms were recorded in the psychodiagnostic instruments. The fewest symptoms were seen in the recurrence-free interval, a moderate number at the beginning of intermittent inpatient treatment and the largest number of symptoms in patients transferred to a psychosomatic department. While decreasing significantly from high levels under internal intensive care and at the beginning of inpatient depth-analysis-based psychotherapy, symptoms of depression and anxiety dropped only slightly from initially low levels in outpatients. In addition, there were first changes in the patients personality profile during psychotherapy. The findings are discussed under diagnostic and therapeutic aspects.

Adaptation, Psychological↗
PubMed1992

[Endometriosis of the terminal ileum--differential diagnosis of Crohn disease].

Ileocecal resection was performed in two female patients with stenosis of the terminal ileum. Histological findings confirmed the clinical diagnosis of Crohn's disease in the first case, although focal intestinal endometriosis was detected. The resection specimens of the other patient exclusively showed lesions of endometriosis extending from the subserosa to the mucosal tissue. Typical lesions of Crohn's disease were totally absent in this case. Although not very frequent, endometriosis is an important differential diagnosis of Crohn's disease in young females.

Adult↗
PubMed1991

[Multilocular angiosarcoma with involvement of the heart].

A thyroid tumour, initially diagnosed as an anaplastic carcinoma of the thyroid, was removed in a 66-year-old woman. Further examination, other than ultrasonography of the abdomen (normal), were refused, 26 months later a painful swelling was noted in the right buttock: a fist-sized haematoma, without evidence of malignancy was removed at another hospital. Computed tomography revealed a cystic tumour in the left upper abdomen, about 8 x 11 cm, not clearly related to any organ. Echocardiography, performed because of atrial fibrillation, demonstrated a space-occupying lesion, 42 x 38 mm, in the left atrium with central necroses and originating broad-based from the interatrial septum and the aortic root. The retroperitoneal upper-abdominal tumour encircling the root of the aorta and a gluteal tumour in the area of the previous haematoma could not be completely removed. Histologically they and the previously removed (and again examined) thyroid tumour were angiosarcomas. Removal of the atrial tumour was not attempted. Six months later it had penetrated the entire atrial septum and grown into the right atrium. The patient had lost 25 kg and three months later died of respiratory failure. Autopsy was refused. The findings suggest a left-atrial angiosarcoma which may well have been the primary tumour site. In case of angiosarcomatous tumours echocardiography should be performed as a staging examination.

Aged↗
PubMed1991

[Social support and its relation to physical and emotional findings in Crohn's disease patients].

It was the aim of the present study to identify correlations between social, psychological and physical findings in 57 unselected patients with Crohn's disease from a gastroenterological outpatient department. Social support was registered using the confidant rating and the social network using a network questionnaire. Additional internal-medical and psychodiagnostic test instruments were used for a specific description of the sample. Anxieties, depressive moods and emotional lability were significantly less pronounced in patients with a confidant than in those without or with a less supportive partner. And the former also seemed to be more able to adequately cope with the disease than the patients of the other groups. With respect to the physical findings, the differences between the groups were less pronounced: Nevertheless, patients who were supported by a partner tended to show lower activity levels for Crohn's disease (Best index) than the others. The results obtained by the network questionnaire were less specific but altogether confirmed the results of the confidant rating. The study confirms the results of comparable investigations done in other clinical patient groups. The construct of social support is discussed critically with respect to psychoanalytical and family-dynamic concepts.

Adaptation, Psychological↗
PubMed1990

[Comparative study of 2 dosage forms of liquid dimethicone for ultrasound premedication].

A double-blind study was carried out to compare the effects of a premedication with 4 x 500 mg dimethylpolysiloxane (DPS)/24 hours and with 2 x 500 mg/12 hours before abdominal ultrasonography. The investigations covered 13 abdominal regions in specified planes. The incidence of the unobscured presentation of the selected organs and organ sections per patient served as a basis for a sonography index. This index was 67%, without significant difference between the two groups. We believe that the optimal conditions for sonography are given when the patient is fasting and two 500 mg doses of DPS are administered, one in the evening before and one in the morning at the day of investigation.

Abdomen, Acute↗